Anterior Cervical Diskectomy and Fusion for Adjacent Segment Disease

Between January 1996 and December 2005, a total of 1241 patients underwent anterior cervical decompression and fusion for cervical degenerative diseases in the authors' institution. Sixty-three (5.1%) patients underwent revision anterior cervical diskectomy and fusion for adjacent segment disease between October 2003 and August 2010. This series included 35 men and 28 women with a mean +/- SD age of 52.6 +/- 6.7 years. A total of 81 segments underwent revision surgery, and most were distributed at C3-C4 and C6-C7. Patients were evaluated using the visual analog scale and Japanese Orthopaedic Association score pre- and postoperatively. Postoperative plain radiographs were used to detect implant failure, segmental collapse, and bone fusion. Clinical symptoms significantly improved postoperatively, and the rate of excellent and good outcomes reached 71.4% at 2-year follow-up. Five (7.9%) patients developed transient mild dysphagia postoperatively. No instrument failure or segmental collapse caused by implant subsidence was detected at the final 2-year follow-up, but 3 (4.8%) patients who received a polyetheretherketone cage did not develop solid fusion. Revision anterior cervical decompression and fusion provided results comparable with those of anterior cervical decompression and fusion as a primary surgery, and no clinical results were associated with the number of operated levels or instrument device type. Therefore, revision surgery does not adversely affect clinical results when performing anterior cervical decompression and fusion in patients with adjacent segment disease, and a Zero-P cage (Synthes GmbH, Oberdorf, Switzerland) is recommended for use in patients due to higher fusion rates.