Prevalence and Risk Factors for Cervical Adjacent Segment Disease and Analysis of the Clinical Effect of Revision Surgery: A Minimum of 5 Years’ Follow-Up

Abstract

Study Design A retrospective study was performed. Objective To investigate the prevalence and risk factors for adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF) and the clinical efficacy of revision surgery. Method A total of 219 patients treated with ACDF were analyzed retrospectively. Demographic characteristics, including age, sex, body mass index (BMI) and bone mineral density (BMD), and radiographic measurements, including C2-C7 cervical sagittal vertical axis (cSVA), T1 slope (T1S), thoracic inlet angle (TIA) and C2-C7 Cobb angle, were analyzed. Modified Japanese Orthopaedic Association (mJOA) score and visual analog scale (VAS) score were used to evaluate patient function. Parameters were analyzed with Student's t test, and potential risk factors for ASD were further analyzed with multivariate logistic regression analysis. Results The incidence of ASD after ACDF surgeries was 21%. The severity of osteoporosis, BMI and C2-C7 cSVA were significantly higher in the ASD group than in the NASD group ( P < .05). The preoperative and postoperative TIAs were lower in the ASD group ( P < .05). Multivariate logistic regression analysis showed that a high BMI, severe osteoporosis and a high C2-C7 cSVA were risk factors for ASD after ACDF ( P < .05). The postoperative TIA and postoperative T1S were also correlated with ASD ( P < .05). Conclusion Patients with a high BMI, severe osteoporosis, and a large C2-C7 cSVA after ACDF have a higher risk of ASD, while a large T1S and TIA may be protective factors. In addition, revision surgery can restore cervical spine balance in patients with ASD and promote better clinical outcomes.

Comparative Analysis of Postoperative Sagittal Balance in Expansive Open-door Laminoplasty versus Laminectomy with Fusion for Multilevel Ossification of Posterior Longitudinal Ligament: A Retrospective Study

“…cSVA is used to indicate the cervical sagittal deviation. It can reflect the cervical functional status, and the larger cSVA, the worse the cervical function [ 31 , 32 ]. We found significantly increased cSVA values in both groups.…”

Anterior cervical corpectomy and fusion-derived adjacent segment disease managed via channel-repairing anterior endoscopic transcorporeal cervical discectomy: A case report

“…To date, the risk factors for ASD remain unclear. Factors such as congenital stenosis, high neck disability index [2], psychiatric disorders, high body mass index, large C2-C7 cervical sagittal vertical axis, and segmental kyphosis are considered as potential risk factors for ASD [6]. ASD is more likely to develop in the superior cervical segment of the fusion level [7,8].…”

Team Approach: Bone Health Optimization in Orthopaedic Surgery

“…The risk of poor bone health is a major concern for orthopaedic surgery. Patients with osteoporosis or other bone-related conditions are at higher risk of postoperative fractures and adverse surgical outcomes 2,9,26-32 . For example, Lindenberg-Larsen et al found that patients with osteoporosis were at increased risk of periprosthetic femoral fracture when undergoing THA 9 .…”

“…Risk factors include older age and female sex, hence the recommendation to start screening women at a younger age than men, low BMI 50-54 with low BMI defined as <21 55 , a history of previous fracture, and a family history of osteoporosis 46,47 . A list of medications and medical conditions leading to increased risk of poor bone health, along with the adverse orthopaedic surgical outcomes associated with poor bone health, are outlined in Table II 2,9,26-31,50-53,56-67 .…”