Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up.
BACKGROUND
Anterior cervical discectomy and fusion using cervical plates has been seen as effective at relieving cervical radiculopathy and myelopathy symptoms. Although it is commonly used, subsequent disc degeneration at levels adjacent to the fusion remains an important problem. However, data on the frequency, impact, and predisposing factors for this pathology are still rare.


OBJECTIVE
To evaluate the incidence, predisposing factors, and impact of radiographic and clinical adjacent-segment pathologies after anterior cervical discectomy and fusion using cervical plates and to analyze the efficacy of this surgical method over the long term, after a minimum follow-up period of 10 years.


METHODS
Retrospective clinical study.


METHODS
Our study was a retrospective analysis of 177 patients who underwent anterior cervical discectomy and fusion using cervical plates, with follow-up periods of at least 10 years (mean 16.2 years).


METHODS
Radiographic adjacent-segment pathology using plain radiographs and clinical adjacent-segment pathology after anterior cervical discectomy and fusion using cervical plates.


METHODS
We defined a new grading system of plain radiographic evidence of degenerative changes in adjacent discs after anterior cervical discectomy and fusion using cervical plates; Grade 0 is considered normal, and Grade V consists the presence of posterior osteophytes and a decrease in disc height to less than 50% of normal. The incidence, predisposing factors, and impact of radiographic and clinical adjacent-segment pathologies were analyzed according to etiologies, number of fused segments, and plate-to-disc distance.


RESULTS
Radiographic and clinical adjacent-segment pathologies were found in 92.1% and 19.2%, respectively, of patients. By etiology, clinical adjacent-segment pathology was observed in 13.5% of patients who had sustained trauma, 12.7% of those with disc herniation, and 33.3% of those with spondylosis. By number of fused segments, clinical adjacent-segment pathology was found in 13.2% of patients who underwent single-level fusion and in 32.1% of those who underwent multilevel fusion surgeries. Patients with a plate-to-disc distance of less than 5 mm, who had spondylosis, or who underwent multilevel fusion had a higher incidence of clinical adjacent-segment pathology after anterior cervical discectomy and fusion using cervical plates than other groups did (p<.05). Of all patients, only 6.8% needed follow-up surgery.


CONCLUSIONS
We found that over the long term, at a minimum follow-up point of 10 years, a plate-to-disc distance of less than 5 mm, having spondylosis, and undergoing multilevel fusion were predisposing factors for the occurrence of clinical adjacent-segment pathology. Nevertheless, the incidence of clinical findings of adjacent-segment pathology was much lower than the incidence of radiographic findings. Also, the rate of follow-up surgery was low. Therefore, anterior cervical discectomy and fusion using cervical plates can be considered a safe and effective procedure.
Department of Orthopedic Surgery, Chonnam National University Hospital, 8 Hakdong, Donggu, Gwangju 501-757, Republic of Korea.
Jae-Yoon
JY
Chung
Department of Orthopedic Surgery, Chonnam National University Hospital, 8 Hakdong, Donggu, Gwangju 501-757, Republic of Korea. Electronic address: bonjourksk@hanmail.net.
Sung-Kyu
SK
Kim
Department of Orthopedic Surgery, Chonnam National University Hospital, 8 Hakdong, Donggu, Gwangju 501-757, Republic of Korea.
Sung-Taek
ST
Jung
Department of Orthopedic Surgery, Chonnam National University Hospital, 8 Hakdong, Donggu, Gwangju 501-757, Republic of Korea.
Keun-Bae
KB
Lee
D000328:Adult; D000368:Aged; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
Adjacent-segment pathology; Cervical vertebrae; Clinical; Follow-up surgery; Long-term follow-up; Plate; Radiography; Spinal fusion