Adjacent segment disease after anterior cervical discectomy and fusion: Incidence and clinical outcomes of patients requiring anterior versus posterior repeat cervical fusion

Mohamad Bydon; Risheng Xu; Rafael De la Garza-Ramos; Mohamed Macki; Daniel M Sciubba; Jean-Paul Wolinsky; Timothy F Witham; Ziya L Gokaslan; Ali Bydon

doi:10.4103/2152-7806.130676

Adjacent segment disease after anterior cervical discectomy and fusion: Incidence and clinical outcomes of patients requiring anterior versus posterior repeat cervical fusion

Surg Neurol Int. 2014 Apr 16;5(Suppl 3):S74-8. doi: 10.4103/2152-7806.130676. eCollection 2014.

Authors

Mohamad Bydon¹, Risheng Xu², Rafael De la Garza-Ramos¹, Mohamed Macki¹, Daniel M Sciubba¹, Jean-Paul Wolinsky¹, Timothy F Witham¹, Ziya L Gokaslan¹, Ali Bydon¹

Affiliations

¹ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Johns Hopkins Biomechanics and Surgical Outcomes Laboratory, Baltimore, MD, USA.
² Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Johns Hopkins Biomechanics and Surgical Outcomes Laboratory, Baltimore, MD, USA ; Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Abstract

Background: Adjacent segment disease (ASD) is a well-recognized long-term outcome in patients with degenerative disease of the spine. In this manuscript, we focus on the development in ASD in patients who have undergone a prior anterior cervical discectomy and fusion (ACDF).

Methods: Patient data were collected via clinical notes and patient interviews. Patients were followed for an average of 92.4 ± 72.6 months after the index ACDF.

Results: Of the 108 patients who underwent revision surgery due to symptomatic ASD, 77 patients underwent re-do ACDF, while 31 patients had posterior fusion surgery. Patients were more likely to be operated on posteriorly if they were older (P = 0.0115), male (P = 0.006), or had a higher number of cervical vertebral segments fused during the index ACDF (P = 0.013). These patients were statistically also more likely to exhibit myelopathic symptoms (P = 0.0053), and usually had worse neurologic function as assessed on the Nurick (P = 0.0005) and ASIA scales (P = 0.0020). Postoperatively, patients receiving anterior revision surgeries had higher rates of recurrent radiculopathy (P = 0.0425) and higher recurrence of ASD compared with patients fused posteriorly (P < 0.0001).

Conclusions: Patients undergoing an anterior revision surgery for ASD after ACDF have higher rates of postoperative radiculopathy and redevelopment of ASD when compared with posteriorly approached patients. Patients receiving posterior revision surgery had higher intraoperative blood loss, hospitalizations, and postoperative complications such as wound infections and discharge to rehabilitation, but had a statistically lower chance of redevelopment of ASD requiring secondary revision surgery. This may be due to the fact that posterior revision surgeries involved more levels fused. This study provides one of the longest and most comprehensive follow-ups of this challenging patient population. Prospective studies comparing surgical approaches and techniques are needed to corroborate our findings.

Keywords: Adjacent level disease; adjacent segment disease; anterior cervical discectomy and fusion; cervical; spine.

Grants and funding

T32 GM007309/GM/NIGMS NIH HHS/United States