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. 2020 Jun 30;14(3):278-285.
doi: 10.14444/7037. eCollection 2020 Jun.

Adjacent Segment Pathology After Treatment With Cervical Disc Arthroplasty or Anterior Cervical Discectomy and Fusion, Part 2: Clinical Results at 7-Year Follow-Up

Pierce D Nunley  1 , Eubulus J Kerr 3rd  1 , David A Cavanaugh  1 , Phillip Andrew Utter  1 , Peter G Campbell  1 , Rishi Wadhwa  1 , Kelly A Frank  1 , Kyle E Marshall  1 , Marcus B Stone  1
Affiliations

Adjacent Segment Pathology After Treatment With Cervical Disc Arthroplasty or Anterior Cervical Discectomy and Fusion, Part 2: Clinical Results at 7-Year Follow-Up

Pierce D Nunley et al. Int J Spine Surg. .

Abstract

Background: Adjacent segment pathology (ASP) following cervical disc arthroplasty (CDA) or anterior cervical discectomy and fusion (ACDF) is identified by imaging (RASP) or clinical symptoms (CASP). Clinical symptoms of CASP have been broadly defined, but subsequent adjacent-level surgeries are clear indicators of CASP. Current literature remains inconsistent in the incidence and potential predictors of CASP. Here, we will evaluate a robust data set for the incidence of CASP resulting in subsequent surgery, attempt to identify factors that might affect CASP, and analyze the association of CASP with patient-reported outcomes (PROS) and RASP.

Methods: Data were prospectively collected during a US Food and Drug Administration randomized, multicenter, investigational device exemption trial comparing CDA (Mobi-C, Zimmer Biomet, Westminster, CO) with ACDF. CASP was defined as any adjacent-level subsequent surgical intervention. Post hoc analyses were conducted on the incidence, time to CASP diagnosis, and relationship of CASP with patient demographics. Longitudinal retrospective case-control analysis was used to assess the correlation of CASP to PROs and radiographic adjacent segment pathology (RASP).

Results: Kaplan-Meier estimates indicated significantly lower probability of CASP over time for 1-level (P = .002) and 2-level (P = .008) CDA patients. Treatment with ACDF and younger age were associated with higher CASP risk. CDA was more effective than ACDF (70.5%; 95% CI = 45.1, 84.2; P < .0001) at preventing CASP. Case-control analysis indicated increased probability of CASP for patients with grade 3/4 RASP, but the difference was not statistically significant. When we pooled CASP patients, the median grade of RASP at the visit prior to surgery was 1, with only 6 patients presenting with grade 3/4 RASP.

Conclusions: Patients treated with CDA have a lower incidence of CASP than do patients treated with ACDF, although the mechanism remains unclear. CASP and RASP remain uncorrelated in this large data set, but other predictive variables such as treatment, age, and number of levels should be further investigated.

Keywords: adjacent segment pathology; anterior cervical discectomy and fusion; cervical disc arthroplasty.

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Conflict of interest statement

Disclosures and COI: Pierce Nunley receives royalties from K2M, Zimmer Biomet, Camber Spine, and Integrity Spine; is on the speakers bureau for K2M, Zimmer Biomet, Spineology, and Camber Spine; and is a paid consultant for K2M, Zimmer Biomet, Spineology, Vertiflex, Camber Spine, Integrity Spine, and Centinel Spine. He has stock or stock options in Paradigm, Spineology, and Camber Spine. Peter Campbell is a paid consultant for 4Web and Titan Spine. The other authors received no funding for this study and report no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan Meier: One-level patients time to grade 3/4 clinical adjacent segment pathology (CASP).
Figure 2
Figure 2
Kaplan Meier: Two-level patients time to grade 3/4 clinical adjacent segment pathology (CASP).
Figure 3
Figure 3
Case-control analysis: longitudinal neck disability index (NDI) score by case-control status.
Figure 4
Figure 4
Case-control analysis: longitudinal visual analog scale (VAS) score by case-control status.
See this image and copyright information in PMC

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