title: Adjacent segment disease after anterior cervical interbody fusion: a multicenter retrospective study of 288 patients with long-term follow-up.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  IV - Multicenter retrospective study.
authors.affiliation: Service de neurochirurgie, hôpital Pasteur, 30, avenue Voie-Romaine, 06002 Nice, France. Electronic address: litrico.s@chu-nice.fr.
authors.forename: S
authors.initials: S
authors.lastname: Litrico
authors.affiliation: Département de neurochirurgie, hôpital Gui-De-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
authors.forename: N
authors.initials: N
authors.lastname: Lonjon
authors.affiliation: Service de chirurgie orthopédique et traumatologie, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Riouallon
authors.affiliation: Service d'orthopédie et de traumatologie, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Cogniet
authors.affiliation: Service de neurochirurgie, hôpital neurologique et neurochirurgical Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron cedex, France.
authors.forename: O
authors.initials: O
authors.lastname: Launay
authors.affiliation: Service de neurochirurgie, centre hospitalier universitaire, 14, rue Gaffarel, 21079 Dijon cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Beaurain
authors.affiliation: Hôpital privé Saint-Grégoire, 6, boulevard Boutière CS 56816, 35768 Saint Gregoire cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Blamoutier
authors.affiliation: Service de chirurgie orthopédique et traumatologie, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Pascal-Mousselard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020968:Brachial Plexus Neuritis / Q000453:epidemiology*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000601:surgery*; D055959:Intervertebral Disc Degeneration / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adjacent segment disease; Cervical spine; Disc degeneration; Long-term follow-up; Revision surgery