Article
The incidence of lumbar disc surgery following anterior cervical discectomy and fusion. Is the development of symptomatic adjacent segment degeneration a predictive factor? A 29 year follow-up study
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Authors
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Benedikt Burkhardt
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Moritz Brielmaier
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Karsten Schwerdtfeger
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Joachim Oertel
- Universitätsklinikum des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Anterior cervical discectomy and fusion (ACDF) is a recognized procedure for the treatment ofcervical disc disease.It is unclear if ACDFcausessymptomaticadjacent segment disease(sASD) which might be followed by futher surgery. Further it remains unclear if there is a correlation between the occurrence of sASD and the development of other degenerative disease of the spine.
Methods: A retrospective file review of patients who underwent ACDF at least 20 years ago was performed. All patients with a complete file, a detailed operative note and current personal contact information were contacted. Patients were questioned about reoperation of the cervical spine and about lumbar disc surgery. Patients were also asked about any procedure of the musculoskeletal joints, smoking habits and their physical work.
Results: 137 of 333 patients who fulfilled the inclusion criteria participated at the study, 136 patients were not interested without giving reasons and 64 patients were either dead or physically and mentally not able to conduct a questionnaire. The mean follow-up was 29 years. 28 patients (20.4%) underwent reoperation at the cervical spine and in19 casesfor treatment of degenerative disorders.12 patients (8.5%) underwent repeated procedure for sASD and6 among those underwent an additional procedure for the treatment at the lumbar disc herniation,2 patients had surgery at the shoulder,4 patients at the knee and none at the hip till the follow-up. 26 among patients without a reoperation for sASD had a lumbar discprocedure, 13had surgery at the shoulder, 33 had knee surgery, and8 had hip surgery. Patients with sASD had a significantly higher rate of procedures for lumbar disc herniation (p=0.033) compared to patients without sASD. No significant differences were seen regarding the rate of procedure at the shoulder, knee and hip. Physical work and smoking had no influence on the rate of repeated procedures.
Conclusion: The rate for repeated procedures due sASD following ACDF was 8.5% in a 29 years follow-up. Patients with repeated procedure due to sASD had a significantly higher rate of procedure for lumbar disc herniation compared to patients without sASD. In the authors opinion this correlation should be further investigated.
