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. 2022 Jan 22:2:100869.
doi: 10.1016/j.bas.2022.100869. eCollection 2022.

Clinical adjacent segment pathology after anterior cervical discectomy, with and without fusion, for cervical degenerative disc disease: A single center retrospective cohort study with long-term follow-up

Valérie N E Schuermans  1   2 , Anouk Y J M Smeets  1   2 , Nienke P M H Wijsen  3 , Inez Curfs  4 , Toon F M Boselie  1   2 , Henk van Santbrink  1   2   5
Affiliations

Clinical adjacent segment pathology after anterior cervical discectomy, with and without fusion, for cervical degenerative disc disease: A single center retrospective cohort study with long-term follow-up

Valérie N E Schuermans et al. Brain Spine. .

Abstract

Introduction: Clinical adjacent segment pathology (CASP) continues to be a cause of concern after anterior surgical treatment for single- or multilevel cervical degenerative disc disease (CDDD). The current literature reports inconsistent incidence rates and contended risk factors in the development of CASP.

Research question: The aim is to determine the incidence of additional CASP-related surgeries after anterior cervical discectomy with fusion (ACDF) or without fusion (ACD) for CDDD. Secondary outcomes include risk factors for the development of CASP and long-term clinical outcomes.

Materials & methods: This is a single-center, retrospective cohort study with a long-term follow up. Patients undergoing ACD(F) for CDDD between January 2012 and December 2019 were included.

Results: A total of 601 patients were included, with an average follow-up period of 5.0 years. Most patients underwent ACDF with stand-alone cages (87.7%). CASP developed in 58 (9.7%) patients, 41 (70.7%) of which required additional adjacent level surgery. ACD significantly accelerated the development of CASP. The C2-C7 Cobb angle appeared less lordotic upon early post-operative imaging in ACDF patients that later-on developed CASP. Baseline degeneration at the index level and adjacent levels was not significantly different between patients with and without CASP.

Discussion & conclusion: In this retrospective cohort, we observe a relatively low rate of additional surgery for CASP in ACDF with stand-alone cages. We suggest that surgical technique, fusion, segmental kyphosis and natural degeneration play a multifactorial role in the development of CASP. Complication rates were low and clinical outcomes were similar for all techniques used.

Keywords: Adjacent segment pathology; Anterior cervical discectomy and fusion; Cervical degenerative disc disease; Cervical myelopathy; Cervical radiculopathy.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flowchart of patient selection. ACD ​= ​Anterior Cervical Discectomy, ACDF ​= ​Anterior Cervical Discectomy and Fusion, CDDD = Cervical Degenerative Disc Disease
Fig. 2
Fig. 2
Time from initial surgery to additional adjacent segment surgery for CASP. This histogram represents the number of patients undergoing additional adjacent segment surgeries for CASP divided per time in years. Frequency represents the number of patients.
Fig. 3
Fig. 3
a. Kaplan-Meier Hazard Function X-axis depicting time to additional adjacent segment surgery for CASP, Y-axis depicting Cumulative Hazard Ratio. b. Kaplan-Meier Hazard Function. X-axis depicting time to additional adjacent segment surgery for CASP with type of intervention as a factor. Y-axis depicting Cumulative Hazard Ratio. Survival and Hazard functions are cut at 8 years follow-up time to prevent skewing by shorter follow-up times.
Fig. 3
Fig. 3
a. Kaplan-Meier Hazard Function X-axis depicting time to additional adjacent segment surgery for CASP, Y-axis depicting Cumulative Hazard Ratio. b. Kaplan-Meier Hazard Function. X-axis depicting time to additional adjacent segment surgery for CASP with type of intervention as a factor. Y-axis depicting Cumulative Hazard Ratio. Survival and Hazard functions are cut at 8 years follow-up time to prevent skewing by shorter follow-up times.
Fig. 4
Fig. 4
Long-term clinical outcomes. This table represents the Odom's Criteria of patients that were reached for long-term follow-up. Statistical significance is illustrated with an asterisk “∗”.
See this image and copyright information in PMC

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