Non-mobile Adjacent Level Cervical Spondylolisthesis Does Not Always Require Fusion in Patients Undergoing ACDF

Anand H. Segar; Srikanth N. Divi; Daniel Tarazona; Tristan Fried; Hanna Sandhu; Ian D. Kaye; Christopher K. Kepler; Mark F. Kurd; Barrett I. Woods; Alan S. Hilibrand; Kristen E. Radcliff; Jeffrey A. Rihn; D. Greg Anderson; Alexander R. Vaccaro; Gregory D. Schroeder

doi:10.1097/BRS.0000000000003070

Non-mobile Adjacent Level Cervical Spondylolisthesis Does Not Always Require Fusion in Patients Undergoing ACDF

Anand H. Segar, Srikanth N. Divi^*, Daniel Tarazona, Tristan Fried, Hanna Sandhu, Ian D. Kaye, Christopher K. Kepler, Mark F. Kurd, Barrett I. Woods, Alan S. Hilibrand, Kristen E. Radcliff, Jeffrey A. Rihn, D. Greg Anderson, Alexander R. Vaccaro, Gregory D. Schroeder

^*Corresponding author for this work

Orthopaedic Surgery

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Study Design.Retrospective review of a prospectively maintained database.Objective.Compare outcomes following anterior cervical decompression and fusion (ACDF) between patients with no adjacent level spondylolisthesis (NAS) and adjacent level spondylolisthesis (AS).Summary of Background Data.There are no prior studies evaluating the effect of preoperative adjacent-level cervical spondylolisthesis on outcomes following anterior cervical discectomy and fusion (ACDF).Methods.A retrospective review of consecutive patients who underwent ACDF for degenerative cervical disease was performed. Adjacent level spondylolisthesis was defined on radiographs as anterior displacement (> 1 mm) of the vertebra in relation to an adjacent "to be fused" level. Patients were categorized as either AS or NAS. Preoperative and 1-year postoperative outcomes including Short Form-12 Physical and Mental Component Scores, Neck Disability Index, Visual Analog Score for arm and neck pain, and rate of revision surgery were compared between the two groups. Radiographic changes were also analyzed for patients with AS.Results.A total of 264 patients met the inclusion criteria. There were 53 patients (20.1%) with AS and 211 patients (79.9%) with NAS. Both groups improved significantly from baseline with respect to all patient outcomes and there were no significant differences between the two groups. After accounting for confounding variables, the presence of an AS was not a predictor of any postoperative outcome. Revision rates did not differ between the two groups.Conclusion.Patients with an AS had similar postoperative clinical outcomes compared with NAS. Furthermore, the presence of an AS was not a predictor of poorer clinical outcomes. This is the first study to investigate the effect of AS in patients undergoing ACDF and suggests that an adjacent-level spondylolisthesis does not need to be included in a fusion construct if it is not part of the primary symptom generating pathology.Level of Evidence: 3.

Original language	English (US)
Pages (from-to)	1287-1293
Number of pages	7
Journal	Spine
Volume	44
Issue number	18
DOIs	https://doi.org/10.1097/BRS.0000000000003070
State	Published - Sep 15 2019

Keywords

ACDF
adjacent level spondylolisthesis
anterior cervical decompression and fusion
cervical spondylolisthesis
clinical outcomes
degenerative cervical disease

ASJC Scopus subject areas

Orthopedics and Sports Medicine
Clinical Neurology

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10.1097/BRS.0000000000003070

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Segar, A. H., Divi, S. N., Tarazona, D., Fried, T., Sandhu, H., Kaye, I. D., Kepler, C. K., Kurd, M. F., Woods, B. I., Hilibrand, A. S., Radcliff, K. E., Rihn, J. A., Anderson, D. G., Vaccaro, A. R., & Schroeder, G. D. (2019). Non-mobile Adjacent Level Cervical Spondylolisthesis Does Not Always Require Fusion in Patients Undergoing ACDF. Spine, 44(18), 1287-1293. https://doi.org/10.1097/BRS.0000000000003070

@article{6a5e716cec144764bd4b9945b08240f5,

title = "Non-mobile Adjacent Level Cervical Spondylolisthesis Does Not Always Require Fusion in Patients Undergoing ACDF",

abstract = "Study Design.Retrospective review of a prospectively maintained database.Objective.Compare outcomes following anterior cervical decompression and fusion (ACDF) between patients with no adjacent level spondylolisthesis (NAS) and adjacent level spondylolisthesis (AS).Summary of Background Data.There are no prior studies evaluating the effect of preoperative adjacent-level cervical spondylolisthesis on outcomes following anterior cervical discectomy and fusion (ACDF).Methods.A retrospective review of consecutive patients who underwent ACDF for degenerative cervical disease was performed. Adjacent level spondylolisthesis was defined on radiographs as anterior displacement (> 1 mm) of the vertebra in relation to an adjacent {"}to be fused{"} level. Patients were categorized as either AS or NAS. Preoperative and 1-year postoperative outcomes including Short Form-12 Physical and Mental Component Scores, Neck Disability Index, Visual Analog Score for arm and neck pain, and rate of revision surgery were compared between the two groups. Radiographic changes were also analyzed for patients with AS.Results.A total of 264 patients met the inclusion criteria. There were 53 patients (20.1%) with AS and 211 patients (79.9%) with NAS. Both groups improved significantly from baseline with respect to all patient outcomes and there were no significant differences between the two groups. After accounting for confounding variables, the presence of an AS was not a predictor of any postoperative outcome. Revision rates did not differ between the two groups.Conclusion.Patients with an AS had similar postoperative clinical outcomes compared with NAS. Furthermore, the presence of an AS was not a predictor of poorer clinical outcomes. This is the first study to investigate the effect of AS in patients undergoing ACDF and suggests that an adjacent-level spondylolisthesis does not need to be included in a fusion construct if it is not part of the primary symptom generating pathology.Level of Evidence: 3.",

keywords = "ACDF, adjacent level spondylolisthesis, anterior cervical decompression and fusion, cervical spondylolisthesis, clinical outcomes, degenerative cervical disease",

author = "Segar, {Anand H.} and Divi, {Srikanth N.} and Daniel Tarazona and Tristan Fried and Hanna Sandhu and Kaye, {Ian D.} and Kepler, {Christopher K.} and Kurd, {Mark F.} and Woods, {Barrett I.} and Hilibrand, {Alan S.} and Radcliff, {Kristen E.} and Rihn, {Jeffrey A.} and Anderson, {D. Greg} and Vaccaro, {Alexander R.} and Schroeder, {Gregory D.}",

note = "Publisher Copyright: {\textcopyright} 2019 Wolters Kluwer Health, Inc.",

year = "2019",

month = sep,

day = "15",

doi = "10.1097/BRS.0000000000003070",

language = "English (US)",

volume = "44",

pages = "1287--1293",

journal = "Spine",

issn = "0362-2436",

publisher = "Lippincott Williams and Wilkins",

number = "18",

}

Segar, AH, Divi, SN, Tarazona, D, Fried, T, Sandhu, H, Kaye, ID, Kepler, CK, Kurd, MF, Woods, BI, Hilibrand, AS, Radcliff, KE, Rihn, JA, Anderson, DG, Vaccaro, AR & Schroeder, GD 2019, 'Non-mobile Adjacent Level Cervical Spondylolisthesis Does Not Always Require Fusion in Patients Undergoing ACDF', Spine, vol. 44, no. 18, pp. 1287-1293. https://doi.org/10.1097/BRS.0000000000003070

TY - JOUR

T1 - Non-mobile Adjacent Level Cervical Spondylolisthesis Does Not Always Require Fusion in Patients Undergoing ACDF

AU - Segar, Anand H.

AU - Divi, Srikanth N.

AU - Tarazona, Daniel

AU - Fried, Tristan

AU - Sandhu, Hanna

AU - Kaye, Ian D.

AU - Kepler, Christopher K.

AU - Kurd, Mark F.

AU - Woods, Barrett I.

AU - Hilibrand, Alan S.

AU - Radcliff, Kristen E.

AU - Rihn, Jeffrey A.

AU - Anderson, D. Greg

AU - Vaccaro, Alexander R.

AU - Schroeder, Gregory D.

PY - 2019/9/15

Y1 - 2019/9/15

N2 - Study Design.Retrospective review of a prospectively maintained database.Objective.Compare outcomes following anterior cervical decompression and fusion (ACDF) between patients with no adjacent level spondylolisthesis (NAS) and adjacent level spondylolisthesis (AS).Summary of Background Data.There are no prior studies evaluating the effect of preoperative adjacent-level cervical spondylolisthesis on outcomes following anterior cervical discectomy and fusion (ACDF).Methods.A retrospective review of consecutive patients who underwent ACDF for degenerative cervical disease was performed. Adjacent level spondylolisthesis was defined on radiographs as anterior displacement (> 1 mm) of the vertebra in relation to an adjacent "to be fused" level. Patients were categorized as either AS or NAS. Preoperative and 1-year postoperative outcomes including Short Form-12 Physical and Mental Component Scores, Neck Disability Index, Visual Analog Score for arm and neck pain, and rate of revision surgery were compared between the two groups. Radiographic changes were also analyzed for patients with AS.Results.A total of 264 patients met the inclusion criteria. There were 53 patients (20.1%) with AS and 211 patients (79.9%) with NAS. Both groups improved significantly from baseline with respect to all patient outcomes and there were no significant differences between the two groups. After accounting for confounding variables, the presence of an AS was not a predictor of any postoperative outcome. Revision rates did not differ between the two groups.Conclusion.Patients with an AS had similar postoperative clinical outcomes compared with NAS. Furthermore, the presence of an AS was not a predictor of poorer clinical outcomes. This is the first study to investigate the effect of AS in patients undergoing ACDF and suggests that an adjacent-level spondylolisthesis does not need to be included in a fusion construct if it is not part of the primary symptom generating pathology.Level of Evidence: 3.

AB - Study Design.Retrospective review of a prospectively maintained database.Objective.Compare outcomes following anterior cervical decompression and fusion (ACDF) between patients with no adjacent level spondylolisthesis (NAS) and adjacent level spondylolisthesis (AS).Summary of Background Data.There are no prior studies evaluating the effect of preoperative adjacent-level cervical spondylolisthesis on outcomes following anterior cervical discectomy and fusion (ACDF).Methods.A retrospective review of consecutive patients who underwent ACDF for degenerative cervical disease was performed. Adjacent level spondylolisthesis was defined on radiographs as anterior displacement (> 1 mm) of the vertebra in relation to an adjacent "to be fused" level. Patients were categorized as either AS or NAS. Preoperative and 1-year postoperative outcomes including Short Form-12 Physical and Mental Component Scores, Neck Disability Index, Visual Analog Score for arm and neck pain, and rate of revision surgery were compared between the two groups. Radiographic changes were also analyzed for patients with AS.Results.A total of 264 patients met the inclusion criteria. There were 53 patients (20.1%) with AS and 211 patients (79.9%) with NAS. Both groups improved significantly from baseline with respect to all patient outcomes and there were no significant differences between the two groups. After accounting for confounding variables, the presence of an AS was not a predictor of any postoperative outcome. Revision rates did not differ between the two groups.Conclusion.Patients with an AS had similar postoperative clinical outcomes compared with NAS. Furthermore, the presence of an AS was not a predictor of poorer clinical outcomes. This is the first study to investigate the effect of AS in patients undergoing ACDF and suggests that an adjacent-level spondylolisthesis does not need to be included in a fusion construct if it is not part of the primary symptom generating pathology.Level of Evidence: 3.

KW - ACDF

KW - adjacent level spondylolisthesis

KW - anterior cervical decompression and fusion

KW - cervical spondylolisthesis

KW - clinical outcomes

KW - degenerative cervical disease

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U2 - 10.1097/BRS.0000000000003070

DO - 10.1097/BRS.0000000000003070

M3 - Article

C2 - 31261272

AN - SCOPUS:85071787300

SN - 0362-2436

VL - 44

SP - 1287

EP - 1293

JO - Spine

JF - Spine

IS - 18

ER -

Non-mobile Adjacent Level Cervical Spondylolisthesis Does Not Always Require Fusion in Patients Undergoing ACDF

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