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Kim, Baek, Lee, Lee, Hwang, and Sohn: Prevalence And Risk Factor of Degenerative Disease of Adjacent Segment after Anterior Cervical Arthrodesis
Original Research

J Korean Soc Spine Surg 2010;17(1):1-6.

Published online: 18 March 2010

DOI: https://doi.org/10.4184/JKSS.2010.17.1.1

Prevalence And Risk Factor of Degenerative Disease of Adjacent Segment after Anterior Cervical Arthrodesis

Yung-Tae Kim, M.D., Dong-Hoon Baek, M.D., Choon-Sung Lee, M.D., Dong-Ho Lee, M.D., Changju Hwang, Dong-Wook Sohn, M.D.

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Corresponding auther: Yung-Tae Kim, M.D. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine. 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea TEL: 82-2-3010-3530, FAX : 82-2-488-7877 E-mail: ytkim2@amc.seoul.kr

Received 6 June 2009       Accepted 16 November 2009

© Copyright 2010 Korean Society of Spine Surgery

“This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.”

Abstract

Study Design

A retrospective radiologic and clinical analysis of 48 patients following anterior cervical fusion.

Objectives

To examine the prevalence of symptomatic adjacent segment disease after anterior cervical fusion and determine the risk factors affecting its progression.

Summary of Literature Review

Symptomatic adjacent segment disease appears to occur at a rate of 2% to 3% per year.

Materials and Methods

Forty-eight patients, who were followed up for more than 3 years after anterior cervical arthrodesis, were enrolled in this study. A modification of the Robinson criteria was used for the clinical evaluation and the radiographic grading of Hilibrand was used for the radiology evaluation. Kaplan-Meier survival analysis was used to examine the survival rate. Age, gender, number of fusion segments, preoperative ROM, angle of lordosis, spinal canal diameter and radiologic degeneration of adjacent segments were selected as potential risk factors. The subjects were divided into two groups according to their clinical symptoms.

Results

Symptomatic adjacent segment disease developed in 11 of the 48 patients(22.9%). The disease free survival rates were 88.7%, 82.4% and 58.7% at 5, 10 and 15 years, respectively. A study of the risk factors showed that preoperative degenerative changes and narrow spinal canal in the adjacent segments were significant. However, there were no significant associations with age, gender, number of fusion segments, preoperative ROM and angle of lordosis.

Conclusion

The prevalence of symptomatic adjacent segment disease after anterior cervical fusion was considerable and higher when the patients had preoperative degenerative changes and a narrow spinal canal in the adjacent segments.

Keywords: Cervical spine, Anterior fusion, Adjacent segment disease, Prevalence, Risk factor

REFERENCES

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Fig. 1.
Kaplan-Meier survivorship curve.
jkss-17-1f1.tif
Table 1.
Criteria for the assessment of clinical outcome (modification of Robinson criteria)
Outcome Pain Medication Activity Work status
Excellent None None Normal Normal
Good Mild Occasional use of NSAIDs Normal Normal
Fair Moderate Frequent use of NSAIDs Restricted Limited
Poor Severe Oral use of narcotics Incapacitated Disabled
Table 2.
Radiographic grading of degenerative change at adjacent levels (Hilibrand)
Grade Disease Findings
Plain Radiography Magnetic Resonance Imaging Computed Tomography or Myelography, or Both
I None Normal Normal Normal
II Mild Narrowing of disc space no posterior ostephytes Signal change in intervertebral disc Normal
III Moderate <50% of normal disc Height, posterior osteophytes Herniated nucleus pulposus without neural compression Herniated nucleus pulposus; no nerve-root cutoff or spinal cord compression
IV Severe Same as for grade III Spinal cord compression with or without nerve-root compression Nerve-root cutoff with or without spinal cord compression
Table 3.
The difference of the clinical and radiological parameters between symptomatic patients(n=11) and symptom-free patients(n=37)
  Symptomatic patient (n=11) Symptom-free patient (n=37) p value
Age(years) 50.27±11.8 56.38±9.3 0.113
Gender(male : female) 6:5 20:17 0.977
Number of fusion segment(1 level:2 level) 7:4 16:21 0.235
Preoperative alignment 22.59±10.7 19.71±9.4 0.524
Preoperative ROM 40.75±11.9 32.00±17.1 0.347
Table 4.
The difference of the radiological parameters between symptomatic adjacent segments(n=12) and symptom-free adjacent segments(n=84)
  Symptomatic adjacent segments (n=12) Symptom-free adjacent segments (n=84) p value
Spinal canal diameter of adjacent segment 13.12±1.34 14.51±1.8 0.018
Preoperative radiologic grade of MRI Normal (I): Degenerative (II,III,IV) 2 : 10 46 : 38 0.027
I 2 46  
II 4 24  
III 6 14  
IV 0 0  
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