Artikel
Is there an impact of cervical plating on the development of adjacent segment degeneration after Smith-Robinson procedure? A magnetic resonance imaging study of 84 patients with a 24 year follow-up
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Autoren
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Benedikt Burkhardt
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Andreas Simgen
- Universitätsklinikum des Saarlandes, Klinik für Neuroradiologie, Homburg, Deutschland
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Gudrun Wagenpfeil
- Universitätsklinikum des Saarlandes, Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik, Homburg, Deutschland
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Wolfgang Reith
- Universitätsklinikum des Saarlandes, Klinik für Neuroradiologie, Homburg, Deutschland
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Joachim Oertel
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: ACDF and ACDF+PS are accepted surgical techniques for the treatment of degenerative cervical disc disease. It remains unclear whether anterior cervical plating has an effect on the degenerative process.
To assess whether anterior cervical plating has an influence on adjacent segment degeneration (ASD). A magnetic resonance imaging (MRI) of patients who underwent anterior cervical discectomy and fusion (ACDF) without and with plate stabilization (ACDF+PS) was assessed and compared to each other.
Methods: The mean follow-up was 24 years (17-45 years) and none of the patients had repeat procedure at the cervical spine. A MRI of 84 (50 male, 34 female) patients who underwent ACDF (46 patients) and ACDF+PS (38 patients) was performed to assess and compare the grade of degeneration of adjacent and adjoining segments.
A five step grading system (SDI) including disc signal intensity, anterior and posterior disc protrusion, narrowing of the disc space and foraminal stenosis was used to assess the grade of adjacent and adjoining segments. Further, the disc height and sagittal segmental alignment (SSA) of fused segments were measured.
Results: The disc height of adjacent and adjoining segments were none significantly lower in patients who underwent ACDF+PS. The SDI of the caudal adjacent segment was significantly lower (p> 0.001) in patients following ACDF+PS. According to SDI the comparison showed no further significant differences between ACDF and ACDF+PS. The SSA in patients who underwent ACDF+PS was significantly (p= 0.002) greater.
About 50% to 96% of all adjacent segments showed moderate to severe degenerative changes according to SDI.
Conclusion: Anterior cervical plate has no significant impact to the decrease of disc height and the segmental degeneration of the adjacent and adjoining segments. ACDF+PS seems to preserve lordosis alignment concerning SSA more than ACDF.
