Article
Is there a difference in the grade of degeneration at the cervical spine following anterior cervical fusion with respect to clinical outcome, diagnosis and repeated procedure? A magnetic resonance imaging study of 102 patients with a mean follow-up of 25 years
Ist der Grad der Degeneration der Halswirbelsäule nach zervikaler Fusionunterschiedlich in Bezug auf das klinische Ergebnis, die Diagnose und bei Reoperationen? Eine MRT-Studie von 102 Patienten mit einem mittleren Verlaufuntersuchungszeitraum vom 25 Jahren
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Authors
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Benedikt Burkhardt
- Universität des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Andreas Simgen
- Universität des Saarlandes, Klinik für Neuroradiologie, Homburg, Deutschland
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Matthias Dehnen
- Universität des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Gudrun Wagenpfeil
- Universität des Saarlandes, Institut für Medizinische Biometrie, Epidemiologie und Informatik, Homburg, Deutschland
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Wolfgang Reith
- Universität des Saarlandes, Klinik für Neuroradiologie, Homburg, Deutschland
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Joachim Oertel
- Universität des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Accelerated degeneration of the adjacent segments (ASD), loss of disc height (DH) and loss of segmental alignment (SSA) following anterior cervical fusion (ACDF) is still discussed controversially. It is unclear if the grade of ASD, DH and SSA correlates with clinical outcome, the initial diagnosis, or number of fused levels. The purpose of the present study was to assess the grade of segmental degeneration as well as the clinical outcome and to analyse if they are related.
Methods: Retrospectively, a total of 102 patients who underwent ACDF at a minimum of 18 years ago were identified. At final follow-up, the clinical outcome according to Odoms, Neck disability index (NDI), and reoperation for symptomatic ASD (sASD) were assessed.A five step grading system (SDI) was used for evaluation; it includes disc signal intensity,anterior and posterior disc protrusion, narrowing of the disc space and foraminal stenosis.Further, the disc height (DH) and the sagittal segmental angle (SSA) of fused levels were measured.MRI findings were compared with respect to clinical outcome(NDI: 0-20 vs. >20, Odom’s: clinical success vs. no clinical success), the event of reoperation for sASD, the initial diagnosis (soft disc herniation [SDH] vs. myelopathy [CSM] and spondylosis), and fused levels (1 vs. 2-4 levels).
Results: The mean follow-up was 25 years (range: 18-45). Initial diagnosis was a CDH in 74.5%, and CSM or spondylosis in 25.5% of patients. At follow-up, the mean NDI was 12.4% (range: 0-36%), clinical success was reported by 87.3% of patients, and reoperation rate for sASD was 15.7%. For SDI no significant differences were seen with respect to NDI, Odoms and sASD. Patients diagnosed with CDH had significant more degeneration at the adjacent segments (p= 0.015, p=0.017). Patients with 2-4 level procedure had less degeneration at the caudal adjacent and adjoining segments (p= 0.011, p=0.019). The mean DH at the 1. cranial adjoining segment was significantly lower I patients operated on for CSM or spondylosis and without clinical success. No further significant differences were seen for DH. No significant differences in clinical outcome were seen in patients with lordotic and straight or kyphotic SSA.
Conclusion: The grade of SDI does not differ with respect to clinical outcome. The SDI was lower in patients with multilevel procedures and fusion for SDH. The degree of SSA was not different and DH was hardly different with respect to clinical outcome, diagnosis and number of fused levels.
