Introduction: Cervical disc arthroplasty (CDA) was developed to decrease the incidence of adjacent segment pathology (ASP) through motion preservation. It is uncertain, however, whether CDA can reduce ASP. Moreover, risk factors for ASP after CDA and after anterior cervical discectomy with fusion (ACDF) are not well known.
To evaluate the incidence of and risk factors for radiographic ASP (RASP) and assess clinical outcomes in anterior cervical spinal surgery
Methods: Fourteen patients (2 female and 12 male; mean age 47.1 years) who underwent single-level cervical disc arthroplasty (CDA group) and 28 case-matched patients (4 female and 24 male; mean age 53.6 years) who underwent single-level ACDF (ACDF group) were included in the study.
Presence of RASP was based on observed changes in anterior osteophytes, discs, and calcification of the anterior longitudinal ligament on lateral radiographs. The neck disability index (NDI) and the visual analog scale (VAS) were used to evaluate clinical outcome.
Results: The mean follow-up period was 43.4 months in the CDA group and 44.6 months in the ACDF group. At final follow-up, RASP was observed in 5 (35.7%) CDA patients and 16 (57.1%) ACDF patients (p = 0.272). The interval between surgery and ASP development was 33.8 months in the CDA group and 16.3 months in the ACDF group (p = 0.046). The ASP risk factor analysis indicated the postoperative lordotic angle at C3-7 was significant, with that postoperative cervical global angle being more lordotic in non-ASP patients in both groups. Restoration of lordosis occurred in the CDA group regardless of ASP presence, but HO development was associated with ASP presence in the CDA group. Although postoperative NDI and VAS clinical parameters significantly improved in both groups, the CDA group had significantly greater clinical improvements than those in the ACDF Group when ASP was present. No patient underwent cervical spine surgery due to ASP during the follow-up period.
Conclusions: In both CDA and ACDF patients RASP developed, but CDA was associated with a delay in ASP development. A good clinical outcome was expected, even when ASP developed. Restoration of cervical lordosis at C3-7 was associated with prevention of RASP in both CDA and ACDF.
Patient Care: Application of CDA is benefit in terms of clinical outcome and delayed development of ASP
Learning Objectives: both CDA and ACDF patients RASP developed, but CDA was associated with a delay in ASP development