Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> The authors compared the incidence of radiologically documented changes and symptomatic adjacent-level cervical disc disease after single-level discectomy and subsequent cervical fusion or arthroplasty in two independent prospective clinical studies.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> The patients were treated with the Affinity Anterior Cervical Cage System or the Bryan Artificial Cervical Disc. In each study the patients were required to undergo serial cervical radiography preoperatively and 24 months postoperatively, as well as serial clinical evaluations including documentation of adverse events, neurological status, and results of the 36-item Short Form Health Survey. All serial radiographs were reviewed prior to evaluating the clinical symptoms for development of increasing or new adjacent degenerative disc disease (DDD). Subsequently, the clinical data were analyzed. For various reasons of exclusion, the cases analyzed in the Bryan disc—treated cohort consisted of 74 patients and in the Affinity system—treated cohort there were 158 patients. New anterior osteophyte formation or enlargement, increased narrowing of an interspace, new DDD, and calcification of the anterior longitudinal ligament were the radiological findings indicative of adjacent-level disease. Fusion was associated with a significant increase in x-ray film—based changes of adjacent-disc disease (p = 0.009, odds ratio [OR] 2.44). In the cage fusion series, the incidence of symptomatic adjacent-level DDD was statistically greater than that in the group treated with the artificial disc (p = 0.018), and the patients required a statistically greater number of medical treatments related to episodic symptoms of neck, shoulder, and arm pain attributed to new disc disease (p = 0.001, OR 35.8).</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> In comparing these prospective studies the authors demonstrated that maintaining motion rather than fusion will prevent symptomatic adjacent-disc disease and will decrease adjacent-level radiological indicators of disease at a 24-month postoperative interval.</jats:p>

What are the associative factors of adjacent segment degeneration after anterior cervical spine surgery? Comparative study between anterior cervical fusion and arthroplasty with 5-year follow-up MRI and CT

“…One was modified hilibrand criteria with radiography [1], and the other was with MRI and CT. We defined ASD as all kinds of degenerative changes (e.g. posterior osteophyte, decrease disc height C25 %, disc signal change, disc herniation, ALL and PLL calcification) at final MRI and CT than preoperative MRI and CT [11]. Various measurements were performed on lateral view of cervical spine radiographs in the neutral and dynamic flexion-extension lateral radiographs obtained at each study point.…”

“…Yet, previous studies have reported cases of ASD after ACDF [5,6]. ASD rates varied from 25 to 92 % during a long follow-up period [1,[7][8][9][10][11]. However, previous studies on ASD were done only using radiography or CT. MRI is most sensitive in assessing the degenerative change of a disc, and this is the first study to investigate the incidence and prevalence of adjacent segment disease by radiography, CT and MRI at cervical spine.…”

“…According to recent studies, some investigators have questioned whether arthroplasty would have a long-term success compared to the ACDF, and they recommended for arthroplasty because arthroplasty yields a lower incidence of ASD than ACDF [11,12,15]. However, these studies also were performed using only radiography.…”

Artificial total disc replacement versus fusion for the cervical spine: a systematic review

“…When more than one study addressed the outcome parameters in question, the results were consistent. The available evidence showed directness, meaning Heller [10] Cheng [5] Anderson [1] Mummaneni [13] Nabhan [15] Robertson [17] Country that studies compared the two alternatives in question head to head and addressed the same question as in our research question with respect to population, comparator and outcome. In summary, the strength of evidence for CTDR compared with fusion is moderate.…”

“…They occurred in maximal one-third of patients in both groups. One study demonstrated a significantly higher rate of ADD in the fusion group [17], however, the rate of secondary surgical procedures was not statistically different between the groups (up to 5% of prothesis-patients and up to 9% of fusionpatients had to undergo a re-operation). No procedurerelated deaths were reported.…”