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. 2018 Feb 2;13(1):27.
doi: 10.1186/s13018-018-0717-1.

Risk factors for non-fusion segment disease after anterior cervical spondylosis surgery: a retrospective study with long-term follow-up of 171 patients

Ziqiang Wang  1   2 , Liangliang Zhou  1   2 , Bin Lin  2 , Keran Song  2 , Qinghe Niu  2 , Dongfeng Ren  3 , Jiaguang Tang  4
Affiliations

Risk factors for non-fusion segment disease after anterior cervical spondylosis surgery: a retrospective study with long-term follow-up of 171 patients

Ziqiang Wang et al. J Orthop Surg Res. .

Abstract

Background: The purpose of this study was to investigate the incidence and causes of non-fusion segment disease (NFSD), both adjacent and non-adjacent to a fused segment, after anterior cervical arthrodesis.

Methods: This is a single-center study. Between January 1998 and January 2011, two surgeons' 171 patients who had an anterior cervical decompression and fusion were followed clinically for more than 5 years. The correlation between the incidence of symptomatic non-fusion segment disease and the following clinical parameters (age at operation, fusion levels,) and radiological parameters (number of patients who had a plate, anterior cervical decompression and fusion (ACDF) or corpectomies, preoperative and postoperative cervical spine alignment, Pavlov's ratio at the C5 level, and preoperative existence of a non-fusion segment degeneration on magnetic resonance imaging) was evaluated.

Results: Of the 171 patients reviewed, 16 patients had non-fusion segment disease (9.36%), of which 12 had adjacent segment disease and 4 had non-adjacent segment disease. Postoperative cervical lordosis in the non-fusion segment disease group was significantly smaller than that of the disease-free group (P < 0.001). Fusion levels in the NFSD group were 1.69 whereas 2.26 in disease-free group (P = 0.005). The incidences of disc degeneration in unfused segments was more severe in the NFSD group than in the disease-free group (P = 0.004). The results of binary logistic regression showed that the major factor affecting NFSD is postoperative cervical lordosis (P = 0.000) followed by disc degeneration (P = 0.024). The other parameters did not show a statistically significant difference.

Conclusions: The incidence of symptomatic non-fusion segment disease after anterior cervical arthrodesis has multifactorial causes. Postoperative cervical lordosis and disc degeneration in non-fusion segments were major factors in the incidence of NFSD.

Keywords: Adjacent segment disease; Anterior cervical arthrodesis; Cervical spondylosis; Non-fusion segment disease.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Ethics Committee of the First Affiliated Hospital of General Hospital of PLA. Because of the retrospective nature of the study, informed consent was waived.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
47-year-old man with multilevel cervical intervertebral disc herniation. a, b Preoperative T1-weighted and T2-weighted MRI shows an indentation of dura mater at C3-C4, C4-C5, C5-C6 and C6-C7 levels. c Radiograph after operation shows 3-level fusion from C4-C7. d, e MRI at 6 years after operation indicates complete decompression at C4-C5, C5-C6, and C6-C7 levels, but C3-C4 level shows significant spinal cord compression
Fig. 2
Fig. 2
39-year-old female with C6-C7 cervical intervertebral disc herniation. a, b Preoperative T2-weighted MRI shows left nerve root compression at C6-C7 level and disc degeneration at C3-C4 level. c Radiograph after operation shows C6-C7 fusion. d MRI at 1 year after operation indicates complete decompression at C6-C7, but severe spinal cord compression can be seen at C3-C4 level
See this image and copyright information in PMC

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