Symptomatic adjacent segment disease after single-lever anterior cervical discectomy and fusion

Abstract

The purpose of this study was to determine the incidence and risk factors of symptomatic adjacent segment disease (ASD) following single-lever anterior cervical discectomy and fusion (ACDF) for cervical degenerative diseases.From January 2000 to December 2010, a total of 582 patients with cervical radiculopathy and myelopathy who had undergone single-lever ACDF surgery in the authors’ institution were reviewed retrospectively. Patients who had a revision surgery for symptomatic ASD were selected for this study. The authors analyzed the incidence for ASD after single-lever ACDF. And univariate analysis and logistic regression analysis were performed to identify the risk factors of ASD.Among the 582 patients, 36 patients received subsequent surgical management for ASD after initial single-lever ACDF for an overall prevalence of 6.2%. The average onset time of ASD was 8.5 (2–15) years. The univariate analysis showed that there were no significant differences in sex, duration of disease, BMI, DM, smoking, operative levels, and follow-up period (P > .05) between the 2 groups with and without ASD. There were statistically significant differences in age at the time of operation (χ2 = 4.361, P = .037), and developmental canal stenosis (χ2 = 4.181, P = .041) between patients with and without ASD. The variables of age at the time of operation and developmental canal stenosis were included in a logistic regression model. The logistic regression analysis revealed that age at the time of operation ≤50 years (P = .045, OR = 3.015, 95% CI = 1.024–8.882) and developmental canal stenosis (P = .042, OR = 2.797, 95% CI = 1.039–7.527) were the risk factors for ASD after single-lever ACDF.In the present study, the incidence of symptomatic ASD after single-lever ACDF was 6.2%. And the age at the time of operation ≤50 years and developmental canal stenosis were the risk factors for ASD. The patients ≤50 years old at the time of operation or with developmental canal stenosis are more likely to develop ASD after surgery, and the risk of reoperation will increase.

Clinical Outcomes of Treating Cervical Adjacent Segment Disease by Anterior Cervical Discectomy and Fusion Versus Total Disc Replacement: A Systematic Review and Meta-Analysis

“…This is because patients presenting for ASD from previous ACDF will be older, have established degeneration already by definition, and have previous surgical disruption to surrounding soft tissue, which are all proven risk factors for ASD itself. 26-28 Thus, perhaps the significant differentiator between ACDF and TDR to manage ASD is the long-term success of each procedure in preventing further ASD. Only time will tell if such a superiority exists, as currently the literature is too young to evaluate this, and this will undoubtedly assist clinicians in determining the optimal approach for a patient.…”

Risk factor analysis of axial symptoms after single-segment anterior cervical discectomy and fusion: A retrospective study of 113 patients

“…Baba et al 26 assessed >100 patients undergoing anterior cervical fusion for cervical myelopathy with an average follow-up of 8.5 years, and 25% of these patients subsequently developed new spinal canal stenosis on the adjacent fused segments. In a retrospective study, Wang et al 27 showed that 6.2% of patients undergoing single-segment ACDF developed adjacent segment disease. In the present study, ASD was observed in only 22 (19.5%) patients at the final follow-up, but its occurrence was not associated with AS.…”

Adjacent Segment Pathology After Treatment With Cervical Disc Arthroplasty or Anterior Cervical Discectomy and Fusion, Part 2: Clinical Results at 7-Year Follow-Up

“…Other authors have found predictors of CASP to be age over 50 years at the time of surgery, developmental canal stenosis, preoperative degeneration of adjacent segments, and postoperative imbalance of sagittal alignment. 8,9 Whereas RASP and CASP have been widely reported in the literature, the hypothesis that a correlation exists between them remains unproven. Often publications include the results of both RASP and CASP rates within the studied population, but attempted correlation is not reported.…”