J Korean Neurosurg Soc.  2016 Mar;59(2):129-136. 10.3340/jkns.2016.59.2.129.

Radiologic Findings and Risk Factors of Adjacent Segment Degeneration after Anterior Cervical Discectomy and Fusion : A Retrospective Matched Cohort Study with 3-Year Follow-Up Using MRI

Affiliations
  • 1Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea. ahnsangsoak@hanmail.net
  • 2Department of Neurosurgery, 21 Century Hospital, Ansan, Korea.
  • 3Department of Radiology, Dong-A University Medical Center, Busan, Korea.
  • 4Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea.

Abstract


OBJECTIVE
The purpose of this study was to figure out the radiologic findings and risk factors related to adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) using 3-year follow-up radiography, computed tomography (CT), and magnetic resonance image (MRI).
METHODS
A retrospective matched comparative study was performed for 64 patients who underwent single-level ACDF with a cage and plate. Radiologic parameters, including upper segment range of motion (USROM), lower segment range of motion (LSROM), upper segment disc height (UDH), and lower segment disc height (LDH), clinical outcomes assessed with neck and arm visual analogue scale (VAS), and risk factors were analyzed.
RESULTS
Patients were categorized into the ASD (32 patients) and non-ASD (32 patients) group. The decrease of UDH was significantly greater in the ASD group at each follow-up visit. At 36 months postoperatively, the difference for USROM value from the preoperative one significantly increased in the ASD group than non-ASD group. Preoperative other segment degeneration was significantly associated with the increased incidence of ASD at 36 months. However, pain intensity for the neck and arm was not significantly different between groups at any post-operative follow-up visit.
CONCLUSION
The main factor affecting ASD is preoperative other segment degeneration out of the adjacent segment. In addition, patients over the age of 50 are at higher risk of developing ASD. Although there was definite radiologic degeneration in the ASD group, no significant difference was observed between the ASD and non-ASD groups in terms of the incidence of symptomatic disease.

Keyword

Adjacent segment degeneration; Anterior; Cervical; Fusion; Spondylosis

MeSH Terms

Arm
Cohort Studies*
Diskectomy*
Follow-Up Studies*
Humans
Incidence
Magnetic Resonance Imaging*
Neck
Radiography
Range of Motion, Articular
Retrospective Studies*
Risk Factors*
Spondylosis

Figure

  • Fig. 1 Flow chart depicting patient selection.

  • Fig. 2 Radiologic measurements. Cervical alignment (CA) and segmental angle (SA) was measured in neutral position using Cobb method (A). Upper segmental range of motion (USROM, U2–1) and lower segmental range of motion (LSROM, L2–1) was measured in both flexion and extension position (B and C). Segmental height (SA), upper segmental disc height (UDH), and lower segmental disc height (LDH) was measured along the line passing through the center of the vertebral bodies (D). For formulas and study time point, see Table 1.


Cited by  1 articles

Is Adjacent Segment Disease More Frequent in Proximal Levels in Comparison with Distal Levels? Based on Radiological Data of at Least 2 Years Follow Up with More than 2 Level Thoracolumbar Fusions
Jung-Ho Kim, Dal-Sung Ryu, Seung-Hwan Yoon
J Korean Neurosurg Soc. 2019;62(5):603-609.    doi: 10.3340/jkns.2019.0144.


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