Different surgical approaches for the treatment of adjacent segment diseases after anterior cervical fusion

Abstract

Studies in the literature have not delineated the surgical approaches of symptomatic adjacent segment diseases (ASDs) in patients undergoing reoperation after an initial anterior cervical fusion (ACF). The purpose of this study was to determine the optimal surgical approaches of ASD and the incidence of the dysphagia after reoperation.This was a retrospective study of 49 patients with ASD after an initial ACF surgery, which had undergone a reoperation at our medical center between January 2010 and December 2014. The surgical approaches were used by anterior cervical discectomy and fusion (ACDF), ACDF with the Zero-profile device, laminoplasty, and laminectomy with internal fixation. Patients were classified according to the different surgical approaches of anterior (n = 38) versus posterior (n = 11) groups and ACDF (n = 25) versus Zero-P (n = 13) groups. Clinical evaluations were performed preoperatively and repeated in 24 months after operation.This retrospective study included 26 men and 23 women with a mean age at revision surgery of 54.3 years and ASD onset time of 7.3 years. The patients were followed up with an average of 4.1 years. The reoperation rate was 5.4% in this study. The Japanese Orthopaedic Association (JOA), Neck Disability Index (NDI), and visual analogue scale (VAS) scores demonstrated significant improvements compared with preoperative in both anterior and posterior groups (P < .05). However, there were no differences between the 2 groups (P > .05). The operation time of ACDF group was more than Zero-P group, with significant differences (P < .05). However, there were no differences in JOA, NDI, and VAS scores between the ACDF and Zero-P groups pre- and postoperative (P > .05). A total of 12 (24.5%) patients had dysphagia after reoperation. The incidence of dysphagia in Zero-P group (1/13) was less than ACDF group (11/25), with significant differences (P < .05). There were no cases of major neurological or vascular complications, and wound complications.The clinical situation, initial operation, and secondary preoperative imaging findings were analyzed comprehensively, anterior or posterior approach were chosen, which can effectively relieve spinal cord compression and improve spinal cord function. In ACDF with the Zero-profile device surgery, there was no need to remove the previous internal fixation, shorten the operation time, and reduce the incidence of postoperative dysphagia.

Surgical Strategy and Clinical Efficacy Analysis of Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion

“…A review of the literature, the imaging results of adjacent segmental degeneration after ACDF surgery can be as high as 92% [5,12]. and the reoperation for symptomatic ASD was ranged from 2.1-22% [5]. These results are largely in line with the studies by Hilibrand [13] and Go n [14].…”

“…ASD occurred mostly in the superior adjacent segments. Besides, Hilibrand et al found that C4/5, C5/6, and C6/7 spinal levels had a higher risk of developing symptomatic ASD than other segments [3,5,21]. A total of 22 cases (Table 1) of responsible segments were located in C4/5, C5/6, and C6/7 in the follow-up cases of this study, accounting for 84.62% of all cases.…”

“…However, conventional procedures often use titanium plate xation in the anterior cervical approach, which alters the biomechanical properties of the cervical spine and can accelerate the degeneration of the adjacent segments. A review of the literature, the imaging results of adjacent segmental degeneration after ACDF surgery can be as high as 92% [5,12]. and the reoperation for symptomatic ASD was ranged from 2.1-22% [5].…”

“…Anterior cervical discectomy and fusion were mostly in C4/5, C5/6, and C6/7 segments, After ACDF, the stresses in the non-fused segments are redistributed, while the extension and rotation of the cervical spine extend from top to bottom with progressively decreasing mobility, so that degeneration occurs mostly the superior fused vertebrae [5,19,20]. This study followed 17 cases of superior ASD and 9 cases of inferior ASD.…”

“…Though favored by most surgeons, one cannot deny that the major shortcoming of ACDF is the potential disrupture on the biomechanical characteristics of the cervical vertebra. Clinical and biomechanical studies have shown that increased mobility, intervertebral disc pressure, and stress in adjacent segments following ACDF surgery may accelerate the degeneration of adjacent segments [5,6]. With the study of large-scale clinical cases and the extension of follow-up time, reports on ASD after ACDF surgery also increase year by year, affecting the long-term outcome of the surgery [7].…”