Is there an impact of cervical plating on the development of adjacent segment degeneration following Smith-Robinson procedure? A magnetic resonance imaging study of 84 patients with a 24-year follow-up

• Published in: The spine journal 2019-04, Vol.19 (4), p.587-596
• Main Authors: Burkhardt, Benedikt W., Simgen, Andreas, Dehnen, Matthias, Wagenpfeil, Gudrun, Reith, Wolfgang, Oertel, Joachim M.
• Format: Article
• Language: English
• Subjects: ACDF; Adjacent Segment Degeneration; Adult; Cervical Plate; Cervical Spine; Cervical Vertebrae - surgery; Diskectomy - adverse effects; Diskectomy - methods; Female; Fracture Fixation, Internal - adverse effects; Humans; Intervertebral Disc Degeneration - diagnostic imaging; Intervertebral Disc Degeneration - epidemiology; Intervertebral Disc Degeneration - etiology; Long-term follow-up; Magnetic Resonance Imaging; Male; Middle Aged; MRI; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Spinal Fusion - adverse effects; Spinal Fusion - methods
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2018.09.001

Anterior cervical discectomy and fusion (ACDF) without and with cervical plating (ACDF+CP) are accepted surgical techniques for the treatment of degenerative cervical disc disorders. The effect of CP on the development of adjacent segment degeneration (ASD) remains unclear. To assess whether CP accelerates the degeneration of the adjacent and adjoining segments. This is an imaging cohort study. Retrospectively, a total of 84 patients who underwent ACDF or ACDF+CP were identified. At final follow-up, an MRI was performed and evaluated in this study. An MRI of 84 patients who underwent ACDF (46 patients) and ACDF+PS (38 patients) was performed. The mean follow-up was 24 years (17–45 years). None of the patients had a repeat procedure in the cervical spine. The grade of degeneration of the segments adjacent and adjoining to the fusion was assessed via a five-step grading system (segmental degeneration index, or SDI) that includes disc signal intensity, anterior and posterior disc protrusion, narrowing of the disc space, and foraminal stenosis. Furthermore, the disc height (DH) and sagittal segmental angle (SSA) of fused segments were measured. A significantly (p