S Litrico1, N Lonjon2, G Riouallon3, A Cogniet4, O Launay5, J Beaurain6, A Blamoutier7, H Pascal-Mousselard3. 1. Service de neurochirurgie, hôpital Pasteur, 30, avenue Voie-Romaine, 06002 Nice, France. Electronic address: litrico.s@chu-nice.fr. 2. Département de neurochirurgie, hôpital Gui-De-Chauliac, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France. 3. Service de chirurgie orthopédique et traumatologie, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France. 4. Service d'orthopédie et de traumatologie, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France. 5. Service de neurochirurgie, hôpital neurologique et neurochirurgical Pierre-Wertheimer, 59, boulevard Pinel, 69677 Bron cedex, France. 6. Service de neurochirurgie, centre hospitalier universitaire, 14, rue Gaffarel, 21079 Dijon cedex, France. 7. Hôpital privé Saint-Grégoire, 6, boulevard Boutière CS 56816, 35768 Saint Gregoire cedex, France.
Abstract
INTRODUCTION: Cervical discectomy with interbody fusion is a common procedure in spinal surgery. The resultant biomechanical alterations accelerate degeneration of the adjacent segment, but the contribution of natural degeneration to adjacent segment disease is unclear. OBJECTIVE: To assess the long-term rate of surgery to discs adjacent to cervical interbody fusion; and to assess the associated incidence of cervico-brachial neuralgia and radiological degeneration of adjacent discs. MATERIAL AND METHOD: A multicenter retrospective study included anterior cervical discectomy patients at a minimum of 10 years' follow-up. Clinical variables comprised pain, use of analgesics and surgical revision. Functional assessment was performed on the Neck Disability Index (NDI). Radiologic degeneration was assessed on the Goffin score based on cervical spine X-ray. RESULTS: Two hundred and eighty-eight patients were contacted and filled out the clinical questionnaire. Among the patients, 153 underwent radiological reassessment. Mean age was 46 years (range, 16-73 years). Mean follow-up was 14.5 years (12-18 years). The rate of surgical revision on a disc adjacent to the primary level was 5.9%. Frequent attacks of cervico-brachial neuralgia were reported in 20.5% of cases. Radiologic adjacent segment degeneration was found in 81.3% of cases over follow-up. There was a significant correlation between degree of radiologic adjacent segment degeneration and NDI (P=0.02). DISCUSSION: Degeneration adjacent to discectomy/fusion is partly due to aging. The present findings, however, agree with the literature and indicate accelerated degeneration in adjacent segments. These findings should be taken into account in treatment decision-making and suggest a possible interest of more physiological surgery such as arthroplasty. LEVEL OF EVIDENCE: IV - Multicenter retrospective study.
INTRODUCTION: Cervical discectomy with interbody fusion is a common procedure in spinal surgery. The resultant biomechanical alterations accelerate degeneration of the adjacent segment, but the contribution of natural degeneration to adjacent segment disease is unclear. OBJECTIVE: To assess the long-term rate of surgery to discs adjacent to cervical interbody fusion; and to assess the associated incidence of cervico-brachial neuralgia and radiological degeneration of adjacent discs. MATERIAL AND METHOD: A multicenter retrospective study included anterior cervical discectomy patients at a minimum of 10 years' follow-up. Clinical variables comprised pain, use of analgesics and surgical revision. Functional assessment was performed on the Neck Disability Index (NDI). Radiologic degeneration was assessed on the Goffin score based on cervical spine X-ray. RESULTS: Two hundred and eighty-eight patients were contacted and filled out the clinical questionnaire. Among the patients, 153 underwent radiological reassessment. Mean age was 46 years (range, 16-73 years). Mean follow-up was 14.5 years (12-18 years). The rate of surgical revision on a disc adjacent to the primary level was 5.9%. Frequent attacks of cervico-brachial neuralgia were reported in 20.5% of cases. Radiologic adjacent segment degeneration was found in 81.3% of cases over follow-up. There was a significant correlation between degree of radiologic adjacent segment degeneration and NDI (P=0.02). DISCUSSION: Degeneration adjacent to discectomy/fusion is partly due to aging. The present findings, however, agree with the literature and indicate accelerated degeneration in adjacent segments. These findings should be taken into account in treatment decision-making and suggest a possible interest of more physiological surgery such as arthroplasty. LEVEL OF EVIDENCE: IV - Multicenter retrospective study.
Authors: Joost Dejaegher; Joris Walraevens; Johannes van Loon; Frank Van Calenbergh; Philippe Demaerel; Jan Goffin Journal: Eur Spine J Date: 2016-11-30 Impact factor: 3.134
Authors: Jarle Sundseth; Eva Astrid Jacobsen; Frode Kolstad; Ruth O Sletteberg; Oystein P Nygaard; Lars Gunnar Johnsen; Are Hugo Pripp; Hege Andresen; Oddrun Anita Fredriksli; Erling Myrseth; John A Zwart Journal: Eur Spine J Date: 2016-04-09 Impact factor: 3.134