The Revision Rate and Occurrence of Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion

Study Design. Level III: retrospective cohort study. Objective. The aim of this study was to determine the rate of revision surgery and the occurrence of adjacent segment disease of patients undergoing ACDF for cervical radiculopathy and myelopathy using more modern-day instrumentation techniques. Summary of Background Data. Anterior cervical discectomy and fusion (ACDF) has long been the preferred treatment for cervical radiculopathy and myelopathy. Methods. All patients undergoing ACDF between January of 2000 and December of 2010 were included. Age, sex, height, weight, body mass index, symptoms at presentation, number of levels fused, graft type, and smoking status were recorded. Outcomes included revision rate, reason for revision surgery, time to revision surgery, presence and grade of adjacent segment disease, distance from the instrumentation to the cranial and caudal endplate (plate-to-disc distance), and reporting of symptoms of adjacent segment disease at the final follow-up. Results. A total of 672 patients were included in this study. The average duration of follow-up was 31 months. One hundred one (15%) patients underwent revision surgery. The reason for revision surgery was adjacent segment disease in 47 (47.5%), pseudarthrosis in 45 (45.5%) and a new problem at a nonadjacent level in 7 (7.1%) of those patients. The need for revision surgery was not affected by patient age, sex, body mass index, smoking status, symptoms at presentation, number of levels fused, plate-to-disc distance or graft type. Conclusion. The revision rate after ACDF is 15%. Most revisions were done for either adjacent segment disease or pseudarthrosis. No specific risk factors for revision surgery were identified in this study.