Adjacent segment pathology: natural history or effect of anterior cervical discectomy and fusion? A 10-year follow-up radiological multicenter study using an evaluation scale of the ageing spine
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Aim of this study is to compare late degenerative MRI changes in a subset of patients operated on with ACDF to a second subset of patients presenting indication to ACDF but never operated on.
Patients from both subgroups received surgical indication according to the same criteria. Both subgroups underwent a cervical spine MRI in 2004–2005 and 10 years later in 2015. These MRI scans were retrospectively evaluated with a cervical spine ageing scale.
Comparing the two subset of patients both suffering from clinically relevant single-level disease returns no statistically significant difference in the degenerative condition of posterior ligaments, presence of degenerative spondylolisthesis, foraminal stenosis, diameter of the spinal canal, Modic alteration, and intervertebral discs degeneration at 10-year follow-up.
The adjacent segment degeneration represents, in the present cohort, a result of the natural history of cervical spondylosis rather than a consequence of fusion.
KeywordsCervical spondylosis Ageing spine ACDF Adjacent segment pathology Cervical arthroplasty MRI
Anterior cervical discectomy and fusion
Cervical spine degenerative disease
Cervical degenerative disc disease
Adjacent segment degeneration
Functional spinal unit
Magnetic resonance imaging
Compliance with ethical standards
Conflict of interest
The authors certify that they have no conflict of interest; they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. The authors confirm their adherence to ethical standards and have no financial disclosures that would be a potential conflict of interest with this publication.
Online Enhancing the Quality and Transparency Of health Research check was performed and returned STROBE. All the subheadings included in each paragraph are coherent with STROBE research protocol. This work reaches the STROBE research guidelines required standards.
Research involving human participants and/or animals and informed consent
This is a research project involving human subjects. It is perfectly consistent, in any of its aspect, with WMA Helsinki Declaration of Human Rights. All the patients of the surgical subgroup expressed consent to the surgical procedure after appropriate information. All the patients from both subgroups gave informed explicit consent to undergo the follow-up MRI; before performing the MRI they were elucidated about the purpose of the study.
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