Artikel
Clinical outcome and adjacent level degeneration after cervical fusion long-term follow-up study of 215 patients
Langzeituntersuchung bei 215 Patienten – Klinische Ergebnisse und Degeneration benachbarter Segmente nach zervikaler Fusionsoperation
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Autoren
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S. Pauli
- Klinik für Neurochirurgie, Universitätsklinikum Magdeburg
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B. Jöllenbeck
- Klinik für Neurochirurgie, Universitätsklinikum Magdeburg
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M. Skalej
- Institut für Neuroradiologie, Universitätsklinikum Magdeburg
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R. Firsching
- Klinik für Neurochirurgie, Universitätsklinikum Magdeburg
| Veröffentlicht: | 30. Mai 2008 |
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Gliederung
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Objective: Anterior cervical decompression and fusion has gained popularity because of its applicability to a variety of cervical spine disorders. Long-term follow-ups have demonstrated degenerative changes in segments adjacent to the fusion in up to 25 %. The causes of this condition are controversial. The aim of the present study was to detect the incidence of adjacent segment disease over a period of 10 years.
Methods: 215 patients with anterior cervical decompression and fusion operated in the period from 1995 to 2000 and until now were analyzed. The data acquisition is based on the medical record, the radiological diagnostics with x-ray, CT and MRI, mail questionnaire including a questionnaire for the neck pain disability index (NPDI).
Results: 87 out of the 215 patients responded to the questionnaire. Of these 66% were satisfied after surgery, 19% were not, 50% had returned to work, 69% were minimally or moderately disabled, 31% severe disabled concerning the NPDI. Out of the 215 patients only 12 patients (5,6%) were operated at the adjacent segment. The interval to the reoperation varied from 7 to 132 months (median 60 months).
Conclusions: The outcome of anterior cervical decompression and fusion is mostly quite satisfying, the incidence of adjacent-segment disease is low but remarkable. It remains debatable whether to attribute the cause of the adjacent level degeneration to the fusion or to the underlying tendency toward spinal degeneration. It remains to be investigated in a long-term study to study the incidence of adjacent level disease after motion-preserving surgical techniques, in particular the use of artificial disc prosthesis.
