title: Does incorrect level needle localization during anterior cervical discectomy and fusion lead to accelerated disc degeneration?
abstract: METHODS
  Retrospective radiographic analysis.
  
  
  OBJECTIVE
  To retrospectively review a group of patients undergoing anterior cervical discectomy and fusion (ACDF) to determine the relative risk of adjacent level disc degeneration after incorrect needle localization.
  
  
  BACKGROUND
  The needle puncture technique is a well-established method to cause disc degeneration in experimental animal studies. The risk for accelerated degeneration because of needle puncture in humans is unknown.
  
  
  METHODS
  A retrospective radiographic analysis of 87 consecutive patients after single or 2-level ACDF with anterior plate instrumentation was performed. Perioperative and follow-up radiographs were used to grade disc degeneration according to a previously described scale.
  
  
  RESULTS
  Eighty-seven patients were included in the study (36 underwent 1-level ACDF, and 51 underwent 2-level ACDF). Seventy-two had correct needle localization at the level of planned surgery; 15 had incorrect needle localization (1 level above the operative level). There were no differences between the 2 groups in age, sex and length of follow-up. Patients in the incorrectly marked group were statistically more likely to demonstrate progressive disc degeneration with an odds ratio of 3.2. There was no correlation between age and length of follow-up with development of disc degeneration.
  
  
  CONCLUSIONS
  There is a 3-fold increase in risk of developing adjacent level disc degeneration in incorrectly marked discs after ACDF at short-term follow-up. This may indicate that either needle related trauma or unnecessary surgical dissection contributes to accelerated adjacent segment degeneration.
authors.affiliation: Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA. nassr.ahmad@mayo.edu
authors.forename: Ahmad
authors.initials: A
authors.lastname: Nassr
authors.forename: Joon Y
authors.initials: JY
authors.lastname: Lee
authors.forename: Rubin S
authors.initials: RS
authors.lastname: Bashir
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Rihn
authors.forename: Jason C
authors.initials: JC
authors.lastname: Eck
authors.forename: James D
authors.initials: JD
authors.lastname: Kang
authors.forename: Moe R
authors.initials: MR
authors.lastname: Lim
mesh_terms: D000328:Adult; D003951:Diagnostic Errors / Q000295:instrumentation / Q000379:methods; D018450:Disease Progression; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007403:Intervertebral Disc / Q000293:injuries / Q000473:pathology / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D009339:Needles / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D011843:Radiculopathy / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D055009:Spondylosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery