J Korean Orthop Assoc.  2012 Dec;47(6):425-431. 10.4055/jkoa.2012.47.6.425.

Factors Affecting Adjacent Level Ossification Development after Anterior Cervical Discectomy and Fusion

• Jeong ES
• Choi BY
• Shin CS

• KMID: 2185305
• DOI: http://doi.org/10.4055/jkoa.2012.47.6.425

Abstract

PURPOSE
The purpose of this study is to analyze the affecting factors of adjacent level ossification development (ALOD) after anterior cervical discectomy and fusion.
MATERIALS AND METHODS
This study enrolled 75 patients who underwent anterior cervical discectomy and fusion and were followed-up for more than two years. Twenty-five patients were related with trauma and 47 patients were diagnosed as degenerative cervical disorder. We assessed the incidence, location and timing of ALOD, and compared the incidence of ossification between trauma and degenerative disease groups to know the effect of soft tissue damage. We also reviewed the correlation between the development of ossification at adjacent level and the factors, such as fusion level, age, operation time, duration of follow-up, and the presence of ossification of posterior longitudinal ligament (OPLL), as well as ossification of yellow ligament (OYL).
RESULTS
Ossification developed in 33 patients (44%). Five cases (15%) were detected during the first year after surgery, 10 (30%) cases detected during the second year after surgery, 13 (40%) between second and third year, and 5 (15%) cases of more than three years after surgery. Only the fusion level was related with the development of ossification statistically (p<0.001). Age, operation time, duration of follow-up, sex ratio, presence of OPLL, and OYL were not related with the incidence of ossification significantly. There was no significant difference in the incidence of ALOD between the trauma group and degenerative disease group (p=0.3625).
CONCLUSION
To detect ALOD, it needs a long time for follow-up after surgery. We thought that ALOD is affected by excessive loading at the adjacent level after fusion rather than severity of the soft tissue damage.

Keyword

cervical vertebrae; anterior discectomy and fusion; adjacent level ossification development

MeSH Terms

Cervical Vertebrae
Diskectomy
Female
Follow-Up Studies
Humans
Incidence
Ligaments
Ossification of Posterior Longitudinal Ligament
Sex Ratio

Figure

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  Figure 1 Radiographic parameters on lateral plane radiographs of the cervical spine. The plate-to-disc distances were measured from the tips of the plate to the (A) cephalad and (B) to the caudal, respectively.

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  Figure 2 A 61-year-old female patient had anterior cervical discectomy and fusion with Polyethyletherketone (PEEK) cage (Stryker spine, USA) packed with autogenous iliac bone and plate stabilization for unilateral facet dislocation at C5-6. (A) Preoperative lateral radiograph. (B) Last follow-up radiograph (postoperative 57 months), it shows no change in adjacent levels.

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  Figure 3 A 46-year-old female patient had anterior cervical discectomies and fusions with cages and plate for degenerative cervical spondylosis associated with disc herniation at C5-6, 6-7. (A) Preoperative lateral radiograph. (B) Last follow-up radiograph (postoperative 49 months), it shows ossification in cranial adjacent disc space.

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  Figure 4 A 40-year-old male patient had anterior cervical discectomies and fusions with cages and plate for degenerative cervical spondylosis associated with disc herniation at C5-6, 6-7. (A) Preoperative lateral radiograph. (B) After follow-up of 15 months it shows no definite change in adjacent level. (C) Lateral radiograph at 34 months after surgery shows ossification in caudal adjacent disc space.

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