Surgical Strategies to Prevent Adjacent Segment Disease in the Cervical Spine

Abstract

The most popular approach to treating symptomatic cervical disk disease is anterior cervical discectomy and fusion. Although this procedure has significant long-term clinical success, it is associated with progressive adjacent segment degeneration with an annual incidence of ∼3%. Total disk arthroplasty was designed as an alternative to fusion that could preserve segmental motion at the operative level and potentially delay or prevent adjacent-level breakdown. The etiology of adjacent segment pathology (ASP) is multifactorial, and it is likely that most cases of ASP are unavoidable. When attempting to surgically prevent ASP, it is important to consider nonfusion alternatives, be judicious in one's level selection, and attempt to restore sagittal alignment. When ASP becomes a clinical problem, it is important to have an algorithm for how best to treat it.

A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study

“…Moreover, following the application of a long-segment titanium plate, patients are prone to foreign body sensation, dysphagia, and even esophageal fistula, while the incidence of ASD is also increased. [13][14][15][16][17][18] In the present study, our biomechanical results showed that among the three surgical models involving titanium plate fixation (mACDF, ACCF, and HDF groups), the ACCF group had the highest stress at the plate-screw interface, the HDF group had higher stress than the mACDF group, and the mACDF group had the lowest stress. These results revealed that the risk of titanium plate or screw loosening, displacement, and fracture was the highest following ACCF, which is similar to clinical results.…”

“…The incidence of ASD within 10 years after primary anterior cervical surgery is 25%, and more than 15% of patients require secondary surgery owing to ASD. [16][17][18][51][52][53][54] Controversy continues regarding whether differences exist in the impact of anterior cervical fusion on adjacent segments. Based on a 2-year follow-up of 218 patients undergoing single-or two-level ACCF, Park et al [51] found that the incidence of ASD in the upper adjacent segment was markedly higher than that in the lower adjacent segment following ACCF (58% vs. 28%, respectively).…”

“…[13][14][15] Meanwhile, some researchers argue that the use of anterior cervical titanium plate increases the incidence of adjacent segment degeneration (ASD). [16][17][18] To prevent complications associated with anterior cervical titanium plates and maintain the benefits of interbody cages with anterior plating system, a new zero-profile, stand-alone device (Fidji cervical cage, and translated to various 3D solid volumes of all vertebrae. Then, the solid volumes were created to fill the spaces between the vertebrae to create intervertebral discs.…”

Application of an Expandable Cage for Reconstruction of the Cervical Spine in a Consecutive Series of Eighty-Six Patients

“…The etiology of ASD is multifactorial and most cases are found to be unavoidable. Evaluation of possible nonfusion alternatives and proper selection of corpectomy levels with attempt to restore sagittal alignment are needed when patients have a high risk of developing ASD [34].…”

Single-Level Cervical Arthroplasty with a Keel-less Prosthesis: Results in a Series of 35 Patients Operated on for Soft Disk Herniation with a Minimum of 3 Years of Follow-Up

“…Hilibrand et al 6 detected ASD in ∼25% of the patients with single-level ACDF 10 years after the initial procedure. In a recent article, Butler et al 7 analyzed the strategies to prevent ASD and found its incidence ranging from 0.5 to 4% per year. In a radiographic study, Wigfield et al 8 reported significantly increased motion at the levels adjacent to a fused segment when compared with segments adjacent to an arthroplasty.…”