Abstract
The optimal revision surgical strategy for patients who develop symptomatic adjacent segment disc degeneration (ASD) is controversial. The risks of intraoperative complications, especially the incidence of dysphagia, were relatively high for revision surgeries. This study was aimed at comparing the efficacy of revision surgery using a traditional plate-cage construct and zero-profile anchored spacer (ROI-C) device in treating symptomatic ASD after initial anterior cervical discectomy and fusion (ACDF) surgery. Forty-two patients who developed symptomatic ASD were retrospectively analyzed and classified into two groups (plate-cage group and ROI-C group). The clinical and radiological results were compared. We further evaluated the complication of dysphagia and dysphagia-related risk factors in these patients. The JOA and NDI scores, C2-7 lordotic angle, and intervertebral space height were significantly improved after revision surgery in both groups. The operative time and intraoperative blood loss both significantly decreased in the ROI-C group. The incidence of postoperative dysphagia was much lower in the ROI-C group than in the plate-cage group (18.75% vs. 57.69%; P = 0.01). The presence of dysphagia after initial surgery (P = 0.003) and revision surgery type (P = 0.01) was significantly related to the presence of dysphagia after revision surgery. These results indicated that both the plate-cage construct and ROI-C are effective in treating symptomatic ASD. However, compared with the traditional plate-cage construct, ROI-C with less operative time, less blood loss, and lower incidence of dysphagia is more suitable. Furthermore, ROI-C should preferably be used for patients who present with dysphagia after initial cervical surgery. This study will provide clinical guidance for spinal surgeons to choose the zero-profile device in treating specific and complicated cases, which will significantly improve the therapeutic efficacy of symptomatic adjacent segment degeneration.
Highlights
Anterior cervical discectomy and fusion (ACDF) has been widely applied for cervical degenerative disease since it was first introduced in 1958 [1, 2]
ROI-C should preferably be used for patients who present with dysphagia after initial cervical surgery
No significant differences were found between the two groups in terms of patients’ age, gender, body mass index (BMI), medical history, smoking and alcohol drinking history, interval time between initial and revision surgeries, and type of symptomatic Adjacent segment degeneration (ASD)
Summary
Anterior cervical discectomy and fusion (ACDF) has been widely applied for cervical degenerative disease since it was first introduced in 1958 [1, 2]. Long-term follow-up reveals that disc degeneration adjacent to the fused segment may be a complication secondary to ACDF and should not be neglected. Adjacent segment degeneration (ASD) may be the result of a physiological degenerative process, but several cadaveric and clinical studies have implied that ASD is related to the altered biomechanical environment of the cervical spine caused by fixation and fusion [3, 4]. Adjacent segment disease, known as symptomatic ASD, presents with spinal cord or nerve root compression and results
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