Prevalence and Risk Factors for Cervical Adjacent Segment Disease and Analysis of the Clinical Effect of Revision Surgery: A Minimum of 5 Years' Follow-Up

Abstract

Study design: A retrospective study was performed.

Objective: To investigate the prevalence and risk factors for adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF) and the clinical efficacy of revision surgery.

Method: A total of 219 patients treated with ACDF were analyzed retrospectively. Demographic characteristics, including age, sex, body mass index (BMI) and bone mineral density (BMD), and radiographic measurements, including C2-C7 cervical sagittal vertical axis (cSVA), T1 slope (T1S), thoracic inlet angle (TIA) and C2-C7 Cobb angle, were analyzed. Modified Japanese Orthopaedic Association (mJOA) score and visual analog scale (VAS) score were used to evaluate patient function. Parameters were analyzed with Student's t test, and potential risk factors for ASD were further analyzed with multivariate logistic regression analysis.

Results: The incidence of ASD after ACDF surgeries was 21%. The severity of osteoporosis, BMI and C2-C7 cSVA were significantly higher in the ASD group than in the NASD group (P < .05). The preoperative and postoperative TIAs were lower in the ASD group (P < .05). Multivariate logistic regression analysis showed that a high BMI, severe osteoporosis and a high C2-C7 cSVA were risk factors for ASD after ACDF (P < .05). The postoperative TIA and postoperative T1S were also correlated with ASD (P < .05).

Conclusion: Patients with a high BMI, severe osteoporosis, and a large C2-C7 cSVA after ACDF have a higher risk of ASD, while a large T1S and TIA may be protective factors. In addition, revision surgery can restore cervical spine balance in patients with ASD and promote better clinical outcomes.

Keywords: adjacent segment disease; anterior cervical discectomy and fusion; revision surgery; risk factors; sagittal parameter.

Figure 1.

Male patient, 65 years old. (A/B) Lateral view of the cervical spine during the initial operation. The C2-C7 Cobb angle was decreased and the C2-C7 SVA is increased before the first operation. The C2-C7 Cobb angle increased slightly, but the C2-C7 SVA did not decrease significantly after the first operation. (D/E/F) Lateral cervical view before, after, and at the last follow-up after the reoperation. The patient’s C2-C7 SVA slightly decreased after the reoperation; the C2-C7 Cobb angle did not change significantly, and it was in the normal curvature range. The sagittal balance of the patient’s cervical spine was improved. There was no significant change in the TIA or T1S at any stage.