Artikel
Adjacent segment degeneration after ACDF. Is it a natural course of degeneration or associated to fusion Comparison of adjacent and non-adjacent segments in a long-term follow-up
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Autoren
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Benedikt W. Burkhardt
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Germany
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Matthias Dehnen
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Germany
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Heiko Körner
- Klinik für Neuroradiologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Germany
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Wolfgang Reith
- Klinik für Neuroradiologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Germany
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Joachim M. K. Oertel
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Anterior cervical discectomy and fusion (ACDF) is an accepted procedure for the treatment of degenerative cervical disc disease. Postoperative excellent neurological outcome have been reported. However, degenerative changes at adjacent discs are observed radiologically in up to 60% of patients in a long period of time. The purpose of this study was to determine whether fusion causes adjacent segment degeneration or whether degeneration is due to disease progression.
Method: 101 patients that had undergone a one-, two-, and three-level ACDF with and without Caspar plating (CP) were enrolled in this retrospective study. At minimum follow-up 17 years were required. MRI was conducted for each patient. Disc grading included five categories: disc height, posterior ossification formation, degenerative disc changes, compression of spinal cord, and diameter of the neuroforamen. The difference in degeneration of the disc adjacent to fusion and the adjoining disc were graded and compared to each other.
Results: The mean follow-up was 24.5 years. No difference in the grade of degeneration for the first and the second segment above fusion was found in 63.6% of cases after one-level ACDF+CP and for 81.2% of cases after one-level ACDF. Concerning two-level procedures no difference in the grade of degeneration for the first and the second segment above fusion was found in 91.7% of cases after ACDF+CP and for 72.7% of cases after ACDF. No difference in the grade of degeneration for the first and the second segment below fusion was found in 87.5% of cases after one-level ACDF+CP and for 89.3% of cases after one-level ACDF. No differences were assessed for the first and second segment below two-level ACDF+CP and ACDF.
Conclusions: The grade of degeneration for the segments below the fusion was almost identical after one-level procedure, no difference was assessed after two-level procedure. The grade of degeneration in the adjacent segment above fusion and adjoining segment is identical in 64-82% after one level fusion, and identical in 73%-92% after two level fusion. The authors conclude that adjacent segment disease is more a result of the natural history of cervical spondylosis than the presence of fusion.
