Introduction: Adjacent segment disease (ASD) is characterized by symptomatic degenerative changes at a segment adjacent to a previous spinal fusion. Surgical treatment involves decompression with or without extending the fusion. While outcomes are generally favorable, a 14% reoperation rate has been reported in the lumbar spine, and corresponding outcomes for the cervical spine have not been well characterized. We sought to determine the reoperation rate following revision surgery for cervical ASD.
Methods: A retrospective analysis of a consecutive series of 84 procedures for cervical adjacent segment disease was performed. Data was acquired on patient demographics, comorbidities, perioperative data, and need for additional surgery. Additional procedures were included in the reoperation rate if they occurred at or adjacent to the level of the revision surgery.
Results: A cohort of 84 patients (42 men, 42 women, mean age 56.6 years, mean follow-up time 61.3 months) who underwent surgery for ASD was identified. 69 (82.1%) patients underwent decompression with extension of fusion (64% anterior cervical discectomy and fusion, 36% posterior cervical fusion), and 15 (17.9%) underwent decompression alone. 9 patients (10.7%) required additional surgery at a mean of 20.5 months postoperatively. 5 of these patients developed new ASD adjacent to an extended fusion, 2 patients required fusion of a previously decompressed segment, and 2 required revision of a prior decompression.
Conclusions: Revision surgery for cervical ASD is associated with a long-term reoperation rate of 10.7% and is similar to the corresponding rate in the lumbar spine. While additional studies are needed, these results suggest that need for additional surgery following a revision procedure for cervical ASD is a major concern.
Patient Care: Reoperation is a major source of postoperative morbidity. Knowledge of the reoperation rate following surgery for cervical adjacent segment disease (ASD) is important for preoperative counseling. This information may be especially important to ASD patients, who have already undergone a previous spinal fusion.
Learning Objectives: By the conclusion of this session, participants should be able to:
1. Describe the reoperation rate following surgery for cervical adjacent segment disease (ASD).
2. Discuss the impact the results have on preoperative counseling of patients undergoing surgery for cervical ASD.
3. Compare the reoperation rate following surgery for cervical ASD in this cohort with corresponding reoperation rates in the lumbar spine.