Abstract
Based on long-term follow-ups, this study was designed to investigate the incidence and risk factors for postoperative adjacent segment degeneration (ASD) after anterior cervical discectomy and fusion (ACDF) or total disc replacement (TDR) in treating cervical degenerative diseases. Between January 2000 and December 2005, 108 cases undergoing ACDF and 78 undergoing TDR, were enrolled into this study. All medical records were retrospectively collected. Every patient was followed up at least 10 years. Outcome assessment included visual analogue scale (VAS) score, Neck Disability Index (NDI) score, Japanese Orthopaedic Association (JOA) score, and radiographic parameters. Consequently, thirty-eight (35.2%) of 108 cases suffered from ASD in ACDF group, and 26 (33.3%) of 78 cases in TDR group. There was no statistical difference between the two groups regarding ASD incidence, VAS/NDI/JOA score, recovery rate. Logistic regression analysis showed that age (OR = 2.86, 95% CI, 1.58–4.14) and preoperative segmental lordosis (OR = 1.90, 95% CI, 1.05–3.20) were risk factors associated with increased odds of ASD regardless of surgical procedures. On the other hand, preoperative overall lordosis (OR = 0.54, 95% CI, 0.26–0.82) was most likely protective. In conclusion, advanced age and preoperative segmental lordosis were identified as risk factors for postoperative ASD, while preoperative overall lordosis proves to be a protective factor.
Highlights
Anterior cervical discectomy and fusion (ACDF) which has been considered as the “gold standard” treatment of cervical degenerative diseases was founded by Smith-Robinson and Cloward inthe 1950s1
Postoperative neurological function scores of both ACDF group and total disc replacement (TDR) group were significantly different from preoperative scores respectively, and there was no significant difference between the two groups at different timepoints
It showed that the postoperative clinical results, involving significant improvement in neurological function and quality of life were satisfactory when compared with preoperative status, regardless of surgical procedures, ACDF or TDR
Summary
Anterior cervical discectomy and fusion (ACDF) which has been considered as the “gold standard” treatment of cervical degenerative diseases was founded by Smith-Robinson and Cloward inthe 1950s1. The correlation between so-called “adjacent segment degeneration” and ACDF surgery still needs theoretical and experimental data to support. It is unclear whether ASD after ACDF surgery occurs due to segmental fusion, or it is just the normal physiological degeneration of the spine. Its designed concept is to retain as much as possible the intervertebral disc height and segmental activity, so as to reduce accelerated adjacent segment degeneration (ASD) that may be caused by ACDF surgery. This study was designed to investigate the incidence and risk factors for postoperative ASD after ACDF or TDR surgery, and compare the clinical effects in treating cervical degenerative diseases, based on a long-term follow-up with a minimum of 10 years
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