Clinical adjacent segment pathology after anterior cervical discectomy, with and without fusion, for cervical degenerative disc disease: A single center retrospective cohort study with long-term follow-up

Valérie N E Schuermans; Anouk Y J M Smeets; Nienke P M H Wijsen; Inez Curfs; Toon F M Boselie; Henk van Santbrink

doi:10.1016/j.bas.2022.100869

Clinical adjacent segment pathology after anterior cervical discectomy, with and without fusion, for cervical degenerative disc disease: A single center retrospective cohort study with long-term follow-up

Brain Spine. 2022 Jan 22:2:100869. doi: 10.1016/j.bas.2022.100869. eCollection 2022.

Authors

Valérie N E Schuermans^{1

2}, Anouk Y J M Smeets^{1

2}, Nienke P M H Wijsen³, Inez Curfs⁴, Toon F M Boselie^{1

2}, Henk van Santbrink^{1

2

5}

Affiliations

¹ Department of Neurosurgery, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
² Department of Neurosurgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands.
³ Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands.
⁴ Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC, Heerlen, the Netherlands.
⁵ CAPHRI School for Public Health and Primary Care, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands.

Abstract

Introduction: Clinical adjacent segment pathology (CASP) continues to be a cause of concern after anterior surgical treatment for single- or multilevel cervical degenerative disc disease (CDDD). The current literature reports inconsistent incidence rates and contended risk factors in the development of CASP.

Research question: The aim is to determine the incidence of additional CASP-related surgeries after anterior cervical discectomy with fusion (ACDF) or without fusion (ACD) for CDDD. Secondary outcomes include risk factors for the development of CASP and long-term clinical outcomes.

Materials & methods: This is a single-center, retrospective cohort study with a long-term follow up. Patients undergoing ACD(F) for CDDD between January 2012 and December 2019 were included.

Results: A total of 601 patients were included, with an average follow-up period of 5.0 years. Most patients underwent ACDF with stand-alone cages (87.7%). CASP developed in 58 (9.7%) patients, 41 (70.7%) of which required additional adjacent level surgery. ACD significantly accelerated the development of CASP. The C2-C7 Cobb angle appeared less lordotic upon early post-operative imaging in ACDF patients that later-on developed CASP. Baseline degeneration at the index level and adjacent levels was not significantly different between patients with and without CASP.

Discussion & conclusion: In this retrospective cohort, we observe a relatively low rate of additional surgery for CASP in ACDF with stand-alone cages. We suggest that surgical technique, fusion, segmental kyphosis and natural degeneration play a multifactorial role in the development of CASP. Complication rates were low and clinical outcomes were similar for all techniques used.

Keywords: Adjacent segment pathology; Anterior cervical discectomy and fusion; Cervical degenerative disc disease; Cervical myelopathy; Cervical radiculopathy.