Abstract
Purpose: There is growing concern about the effect of anterior fusion of the cervical spine on the adjacent levels. Long-term assessment is indispensable to understand the mechanisms involved in the degradation observed and to support the development of materials preserving discal mobility.
Material: Three hundred patients who underwent cervical arthrodesis were reviewed in 1996 forty months after the procedure for physical examination and an x-ray work-up including stress views. Cervical spine and radicular pain were assessed on a visual analogue scale.
Methods: A complete data set was available for 136 patients and a partial set for 34. Twenty-two patients only accepted a phone interview. The clinical outcomes in these three groups were not significantly different and the mean scores for these three groups were in the general average in 1996. Eight patients had died.
Results: Patients were divided into three groups by type of disease diagnosed preoperatively (trauma, degenerative spine, myelopathy). Mean follow-up was 102.5 months (range 84 – 180 months).
Trauma: Among the 42 patient reviewed again in 2001, mean deterioration in the subjacent segment increased from 21% in 1996 to 69% in 2001. Deterioration of the supraja-cent segment increased from 26% to 47.6%. Cervical pain remained moderate (20/100 in 1996 and 27/100 in 2001). Degenerative spine (root compression requiring simple discectomy or with arthrodesis or single-level corporectomy): Among the 42 patients reviewed again in 2001, deterioration of the subjacent segment increased from 57% in 1996 to 89% in 2001. Deterioration of the suprajacent segment increased from 22% to 41%. Cervical pain increased from 14/100 in 1996 to 41/100 in 2001.
Myelopathy: Among the 52 patients reviewed again in 2001, deterioration of the subjacent segment increased from 54% in 1996 to 81% in 2001 when there had been one or two corporectomies and from 40% to 70% beyond two. Deterioration of the suprajacent segment increased from 26% to 50%. Cervical pain remained moderate (18/100 in 1996 and 23/100 in 2001).
Conclusion: Although a statistical analysis was not possible because of the small number of patients and the large percentage lost to follow-up, these results confirm that fusion of the cervical spine accelerates the degradation of adjacent levels. Longer follow-up demonstrates that the trauma group “catches up” with the degenerative group.
Use of mobile materials should enable differentiating between effects related to the degenerative process and those induced by the arthrodesis.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
