Adjacent segment disease after anterior cervical interbody fusion. A multicenter retrospective study of 288 patients with long-term follow-up

• Published in: Orthopaedics & traumatology, surgery & research Vol. 100; no. 6; pp. S305 - S309
• Main Authors: Litrico, S, Lonjon, N, Riouallon, G, Cogniet, A, Launay, O, Beaurain, J, Blamoutier, A, Pascal-Mousselard, H
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01-10-2014
• Subjects: Adjacent segment disease; Adolescent; Adult; Aged; Brachial Plexus Neuritis - epidemiology; Cervical spine; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Disc degeneration; Diskectomy - adverse effects; Diskectomy - methods; Female; Follow-Up Studies; Humans; Incidence; Intervertebral Disc - diagnostic imaging; Intervertebral Disc - surgery; Intervertebral Disc Degeneration - epidemiology; Long-term follow-up; Longitudinal Studies; Male; Middle Aged; Orthopedics; Radiography; Reoperation; Retrospective Studies; Revision surgery; Risk Factors; Spinal Fusion - adverse effects; Spinal Fusion - methods; Surgery; Surveys and Questionnaires; Time Factors; Treatment Outcome; Young Adult; Adjacent segment disease; Long-term follow-up; Revision surgery; Disc degeneration; Cervical spine
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2014.07.004

Abstract Introduction Cervical discectomy with interbody fusion is a common procedure in spinal surgery. The resultant biomechanical alterations accelerate degeneration of the adjacent segment, but the contribution of natural degeneration to adjacent segment disease is unclear. Objective To assess the long-term rate of surgery to discs adjacent to cervical interbody fusion; and to assess the associated incidence of cervico-brachial neuralgia and radiological degeneration of adjacent discs. Material and method A multicenter retrospective study included anterior cervical discectomy patients at a minimum of 10 years’ follow-up. Clinical variables comprised pain, use of analgesics and surgical revision. Functional assessment was performed on the Neck Disability Index (NDI). Radiologic degeneration was assessed on the Goffin score based on cervical spine X-ray. Results Two hundred and eighty-eight patients were contacted and filled out the clinical questionnaire. Among the patients, 153 underwent radiological reassessment. Mean age was 46 years (range, 16–73 years). Mean follow-up was 14.5 years (12–18 years). The rate of surgical revision on a disc adjacent to the primary level was 5.9%. Frequent attacks of cervico-brachial neuralgia were reported in 20.5% of cases. Radiologic adjacent segment degeneration was found in 81.3% of cases over follow-up. There was a significant correlation between degree of radiologic adjacent segment degeneration and NDI ( P = 0.02). Discussion Degeneration adjacent to discectomy/fusion is partly due to aging. The present findings, however, agree with the literature and indicate accelerated degeneration in adjacent segments. These findings should be taken into account in treatment decision-making and suggest a possible interest of more physiological surgery such as arthroplasty. Level of evidence IV – Multicenter retrospective study.