title: Adjacent segment disease after anterior cervical decompression and fusion: analysis of risk factors on X-ray and magnetic resonance imaging.
abstract: BACKGROUND
  Adjacent segment disease (ASD) is common after cervical fusion. The aim of this study was to evaluate the risk factors for ASD on X-ray and magnetic resonance imaging (MRI).
  
  
  METHODS
  Patients included in this study had received revision surgeries after developing symptomatic ASD following anterior decompression and fusion. A control group that had not developed ASD was matched 1:1 by follow-up time and fusion segments. Plate-to-disc distances (PDDs), developmental cervical canal stenosis on X-ray, cervical disc degeneration grading, and cervical disc bulge impingements on preoperative MRI were measured and compared between the ASD group and the control group.
  
  
  RESULTS
  Thirty-four patients with complete radiographic data were included in the ASD group. The causative segments of ASD included nine cases of C3-4, 18 cases of C4-5, three cases of C5-6, and four cases of C6-7. The ASD occurred at the upper adjacent segments in 26 patients and at the lower adjacent segments in eight patients. PDD distributions were similar between the ASD group and the control group. Developmental cervical canal stenosis was a risk factor for ASD, with an odd ratio value of 2.88. Preoperative cervical disc degenerations on MRI were similar between the ASD group and the control group. In the upper-level ASD group, the disc bulge impingement was (19.7±9.7)%, which was significantly higher than that of the control group of (11.8±4.8)%.
  
  
  CONCLUSIONS
  ASD was more likely to develop above the index level of fusion. Developmental cervical canal stenosis and greater disc bulge impingement may be risk factors for the development of ASD.
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Yanbin
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, Beijing 100191, China. Email: sunyuor@vip.sina.com.
authors.forename: Yu
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Feifei
authors.initials: F
authors.lastname: Zhou
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Shaobo
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Fengshan
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic Surgery, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Shengfa
authors.initials: S
authors.lastname: Pan
mesh_terms: D002574:Cervical Vertebrae / Q000473:pathology* / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects*; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D013130:Spinal Stenosis / Q000000981:diagnostic imaging