title: Post-traumatic lower cervical spine instability: arthrodesis clinical and radiological outcomes at 5 years.
abstract: BACKGROUND
  Anterior cervical fusion is widely used to treat spinal injuries. Radiological evidence of disc abnormalities may develop on either side of the fused segment, raising concern about the potential for inducing adjacent-segment disease. Here, we report the long-term clinical, functional, and radiological outcomes after anterior cervical fusion.
  
  
  OBJECTIVE
  Anterior cervical fusion influences the development of adjacent-segment disease.
  
  
  METHODS
  In a retrospective study, 15 patients aged 17 to 50 years were re-evaluated more than 5 years after anterior spinal fusion to treat post-traumatic cervical-spine instability. We used the Neck Disability Index (NDI) to assess function. Static and dynamic radiographs of the cervical spine were obtained.
  
  
  RESULTS
  NDI values indicated good clinical and functional outcomes, and fusion was achieved consistently. Adjacent-segment disease was a consistent finding at last follow-up but induced no neurological manifestations. Complete fusion of a level adjacent to the treated level was noted in 2 patients. Revision surgery for adjacent-segment disease was not required in any patient.
  
  
  CONCLUSIONS
  The causative factors of adjacent-segment disease are controversial. Disc degeneration is a normal manifestation of the ageing process. Nevertheless, disc disease is more prevalent at levels adjacent to interbody fusion than in the normal population, suggesting accelerated disc degeneration due to increased loading of the adjacent levels. Furthermore, lesions that are missed during the pre-operative work-up may play a role, as the available investigations do not always have high negative predictive values.
  
  
  METHODS
  Level IV, retrospective study.
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Centre hospitalier universitaire, 45, rue Cognacq-Jay, 51092 Reims cedex, France. Electronic address: vgirard@chu-reims.fr.
authors.forename: V
authors.initials: V
authors.lastname: Girard
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Centre hospitalier universitaire, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Leroux
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Centre hospitalier universitaire, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: V
authors.initials: V
authors.lastname: Brun
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Centre hospitalier universitaire, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Bressy
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Centre hospitalier universitaire, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: H
authors.initials: H
authors.lastname: Sesmat
authors.affiliation: Service de chirurgie orthopédique et traumatologique, Centre hospitalier universitaire, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
authors.forename: K
authors.initials: K
authors.lastname: Madi
mesh_terms: D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging* / Q000209:etiology; D007593:Joint Instability / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D013124:Spinal Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: Adjacent-segment disease; Arthrodesis; Cervical spine; Cervical spine injury; Spinal fusion