Different surgical approaches for the treatment of adjacent segment diseases after anterior cervical fusion: A retrospective study of 49 patients

Abstract

Studies in the literature have not delineated the surgical approaches of symptomatic adjacent segment diseases (ASDs) in patients undergoing reoperation after an initial anterior cervical fusion (ACF). The purpose of this study was to determine the optimal surgical approaches of ASD and the incidence of the dysphagia after reoperation.This was a retrospective study of 49 patients with ASD after an initial ACF surgery, which had undergone a reoperation at our medical center between January 2010 and December 2014. The surgical approaches were used by anterior cervical discectomy and fusion (ACDF), ACDF with the Zero-profile device, laminoplasty, and laminectomy with internal fixation. Patients were classified according to the different surgical approaches of anterior (n = 38) versus posterior (n = 11) groups and ACDF (n = 25) versus Zero-P (n = 13) groups. Clinical evaluations were performed preoperatively and repeated in 24 months after operation.This retrospective study included 26 men and 23 women with a mean age at revision surgery of 54.3 years and ASD onset time of 7.3 years. The patients were followed up with an average of 4.1 years. The reoperation rate was 5.4% in this study. The Japanese Orthopaedic Association (JOA), Neck Disability Index (NDI), and visual analogue scale (VAS) scores demonstrated significant improvements compared with preoperative in both anterior and posterior groups (P < .05). However, there were no differences between the 2 groups (P > .05). The operation time of ACDF group was more than Zero-P group, with significant differences (P < .05). However, there were no differences in JOA, NDI, and VAS scores between the ACDF and Zero-P groups pre- and postoperative (P > .05). A total of 12 (24.5%) patients had dysphagia after reoperation. The incidence of dysphagia in Zero-P group (1/13) was less than ACDF group (11/25), with significant differences (P < .05). There were no cases of major neurological or vascular complications, and wound complications.The clinical situation, initial operation, and secondary preoperative imaging findings were analyzed comprehensively, anterior or posterior approach were chosen, which can effectively relieve spinal cord compression and improve spinal cord function. In ACDF with the Zero-profile device surgery, there was no need to remove the previous internal fixation, shorten the operation time, and reduce the incidence of postoperative dysphagia.

Figure 1

Schematic of patients had a revision surgery for symptomatic ASD after an initial ACF. ASD = adjacent segment disease, ACF = anterior cervical fusion.

Figure 2

A 52-year-old woman developed one-level ASD 7 years after initial surgery. (A) Preoperative MRI of this patient shown severe compressions of the spinal cord at C4-5 level as well as high signal intensity in the spinal cord. (B) Preoperative CT shown ossification formation at C4-5. (C) Radiograph after initial surgery shown ACCF at C4. (D) MRI at 7-year follow-up shown development of ASD and spinal cord compression at C5–6. (E) Radiograph after the reoperation shown ACDF at C5-6 and the fixed plate of the initial surgery was removed. ACCF = anterior cervical corpectomy and fusion, ACDF = anterior cervical decompression and fusion, ASD = adjacent segment disease, CT = computed tomography, MRI = magnetic resonance imaging.

Figure 3

A 40-year-old woman developed one-level ASD 3 years after initial surgery. (A) and (B) Preoperative MRI of this patient shown severe compressions of the spinal cord at C5-6 and C6-7 levels. (C) Radiograph after initial surgery shown ACDF at C5-6 and C6-7. (D) MRI at 3-year follow-up shown development of ASD and spinal cord compression at C4–5. (E) Radiograph after the reoperation shown ACDF with the Zero-profile device at C4-5 and the fixed plate of the initial surgery was not removed. ACDF = anterior cervical decompression and fusion, ASD = adjacent segment disease, MRI = magnetic resonance imaging.

Figure 4

A 66-year-old man developed multi-level ASD 11 years after initial surgery. (A) Preoperative MRI of this patient shown severe compressions of the spinal cord at C4-5 level as well as high signal intensity in the spinal cord. (B) Radiograph after initial surgery shown ACCF at C4. (C) and (D) MRI and CT at 11-year follow-up shown development of ASD and spinal cord compression at C2-3, C3-4, and C6-7. (E) Radiograph after the reoperation shown laminectomy with internal fixation. ACCF = anterior cervical corpectomy and fusion; ASD = adjacent segment disease, CT = computed tomography, MRI = magnetic resonance imaging.