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

  • Alessandro PesceEmail author
  • Venceslao Wierzbicki
  • Emanuele Piccione
  • Alessandro Frati
  • Antonino Raco
  • Riccardo Caruso
Original Article • SPINE - CERVICAL



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.


Cervical spondylosis Ageing spine ACDF Adjacent segment pathology Cervical arthroplasty MRI 



Anterior cervical discectomy and fusion


Cervical spine


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.

Research guidelines

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.


  1. 1.
    Yang B, Li H, Zhang T, He X, Xu S (2012) The incidence of adjacent segment degeneration after cervical disc arthroplasty (CDA): a meta analysis of randomized controlled trials. PLoS ONE 7(4):e35032. doi: 10.1371/journal.pone.0035032 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Okada E, Matsumoto M, Ichihara D, Chiba K, Toyama Y, Fujiwara H, Momoshima S, Nishiwaki Y, Hashimoto T, Ogawa J, Watanabe M, Takahata T (2009) Aging of the cervical spine in healthy volunteers: a 10-year longitudinal magnetic resonance imaging study. Spine 34(7):706–712 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  3. 3.
    Wierzbicki V, Pesce A, Marrocco L, Piccione E, Colonnese C, Caruso R (2015) How old is your cervical spine? Cervical spine biological age: a new evaluation scale. Eur Spine J 24(12):2763–2770. doi: 10.1007/s00586-014-3673-4 (Epub 2014 Nov 23) CrossRefPubMedGoogle Scholar
  4. 4.
    Song KJ, Choi BW, Jeon TS, Lee KB, Chang H (2011) Adjacent segment degenerative disease: is it due to disease progression or a fusion-associated phenomenon? Comparison between segments adjacent to the fused and non-fused segments. Eur Spine J 20(11):1940–1945. doi: 10.1007/s00586-011-1864-9 (Epub 2011 Jun 8) CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Noriega DC, Kreuger A, Brotat M, Ardura F, Hernandez R, Muñoz MF, Barrios C (2013) Long-term outcome of the Cloward procedure for single-level cervical degenerative spondylosis. Clinical and radiological assessment after a 22-year mean follow-up. Acta Neurochir (Wien) 155(12):2339–2344. doi: 10.1007/s00701-013-1902-y (Epub 2013 Oct 10) CrossRefGoogle Scholar
  6. 6.
    Robinson RA, Smith GW (1955) Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 96:223–224Google Scholar
  7. 7.
    Bohlman HH, Emery SE, Goodfellow DB, Jones PK (1993) Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 75:1298–1307CrossRefPubMedGoogle Scholar
  8. 8.
    Hillibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine 4:190S–194S (Phila Pa 1976) CrossRefGoogle Scholar
  9. 9.
    Chung JY, Kim SK, Jung ST, Lee KB (2014) Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up. Spine J 14(10):2290–2298. doi: 10.1016/j.spinee.2014.01.027 CrossRefPubMedGoogle Scholar
  10. 10.
    Xia XP, Chen HL, Cheng HB (2013) Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine 38(7):597–608. doi: 10.1097/BRS.0b013e318273a2ea (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  11. 11.
    Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528CrossRefPubMedGoogle Scholar
  12. 12.
    Cho SK, Riew KD (2013) Adjacent segment disease following cervical spine surgery. J Am Acad Orthop Surg 21(1):3–11CrossRefPubMedGoogle Scholar
  13. 13.
    Dmitriev AE, Cunningham BW, Hu N, Sell G, Vigna F, McAfee PC (2005) Adjacent level intradiscal pressure and segmental kinematics following a cervical total disc arthroplasty: an in vitro human cadaveric model. Spine 30(10):1165–1172 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  14. 14.
    Elsawaf A, Mastronardi L, Roperto R, Bozzao A, Caroli M, Ferrante L (2009) Effect of cervical dynamics on adjacent segment degeneration after anterior cervical fusion with cages. Neurosurg Rev 32(2):215–224. doi: 10.1007/s10143-008-0164-2 (Epub 2008 Oct 10, discussion 224) CrossRefPubMedGoogle Scholar
  15. 15.
    Nassr A, Lee JY, Bashir RS, Rihn JA, Eck JC, Kang JD, Lim MR (2009) Does incorrect level needle localization during anterior cervical discectomy and fusion lead to accelerated disc degeneration? Spine 34(2):189–192 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  16. 16.
    Lundine KM, Davis G, Rogers M, Staples M, Quan G (2014) Prevalence of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion based on pre-operative MRI findings. J Clin Neurosci 21(1):82–85. doi: 10.1016/j.jocn.2013.02.039 (Epub 2013 Sep 11) CrossRefPubMedGoogle Scholar
  17. 17.
    Matsumoto M, Okada E, Ichihara D, Watanabe K, Chiba K, Toyama Y, Fujiwara H, Momoshima S, Nishiwaki Y, Iwanami A, Ikegami T, Takahata T, Hashimoto T (2010) Anterior cervical decompression and fusion accelerates adjacent segment degeneration: comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study. Spine 35(1):36–43 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  18. 18.
    Baba H, Furusawa N, Imura S, Kawahara N, Tsuchiya H, Tomita K (1993) Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. Spine 18:2167–2173 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  19. 19.
    Goffin J, Geusens E, Vantomme N, Quintens E, Waerzeggers Y, Depreitere B, van Calenbergh F, van Loon J (2004) Long-term follow-up after interbody fusion of the cervical spine. J Spinal Disord Tech 17(2):79–85CrossRefPubMedGoogle Scholar
  20. 20.
    Levin DA, Hale JJ, Bendo JA (2007) Adjacent segment degeneration following spinal fusion for degenerative disc disease. Bull NYU Hosp Jt Dis 65(1):29–36PubMedGoogle Scholar
  21. 21.
    Prescher A (1998) Anatomy and pathology of the aging spine. Eur J Radiol 27(3):181–195CrossRefPubMedGoogle Scholar
  22. 22.
    Nunley PD, Jawahar A, Kerr EJ 3rd, Gordon CJ, Cavanaugh DA, Birdsong EM, Stocks M, Danielson G (2012) Factors affecting the incidence of symptomatic adjacent-level disease in cervical spine after total disc arthroplasty: 2- to 4-year follow-up of 3 prospective randomized trials. Spine 37(6):445–451. doi: 10.1097/BRS.0b013e31822174b3 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  23. 23.
    Coric D, Kim PK, Clemente JD, Boltes MO, Nussbaum M, James S (2013) Prospective randomized study of cervical arthroplasty and anterior cervical discectomy and fusion with long-term follow-up: results in 74 patients from a single site. J Neurosurg Spine 18(1):36–42CrossRefPubMedGoogle Scholar
  24. 24.
    Lunsford LD, Bissonette DJ, Jannetta PJ, Sheptak PE, Zorub DS (1980) Anterior surgery for cervical disc disease. Part 1: treatment of lateral cervical disc herniation in 253 cases. J Neurosurg 53(1):1–11CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2017

Authors and Affiliations

  1. 1.Neurosurgery Division, NESMOS Department, A.O. “Sant’Andrea”Sapienza University of RomeRomeItaly
  2. 2.Neurosurgery Division, Dipartimento Scienze Neurosensoriali, Rome Army Hospital “Celio”Sapienza University of RomeRomeItaly
  3. 3.Radiology Division, Dipartimento Scienze Scienze Radiologiche, Rome Army Hospital “Celio”Sapienza University of RomeRomeItaly
  4. 4.Neurosurgery Division, IRCCS “Neuromed”Sapienza University of RomePozzilliItaly

Personalised recommendations