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Neck News

Predicting Disc Disease after Neck Fusion

Many studies have been done on anterior cervical interbody fusion (ACIF) for the neck. There is ongoing concern about breakdown years later at the discs above and below the area of fusion. This study looks at how often this happens and what makes the nearby discs degenerate.

Degenerative changes in the discs above or below a fused segment in the cervical spine are seen on X-ray in up to half of all cases. In this study 112 patients were followed for more than two years. Some patients were seen for up to 19 years after the first operation.

Everyone had the same operation. First the disc was removed from between two vertebral bones. Then the front(anterior) side of the neck was fused using bone from the patient's own pelvis. Patients wore a neck brace right after surgery and started walking five days later.

The authors report a 19 percent rate of symptoms of next level disease after ACIF. Patients who already had disc damage above or below the level operated on were more likely to have disc problems later. These doctors suggest the data shows disc disease next to the fused level is just a natural progression of the disc degeneration already taking place. It was there before the first operation ever took place.

The question now is: should the surgeon fuse all levels that look damaged, even if the patient isn't having any symptoms from that level? The authors don't think so. Some patients can get better without surgery. In this study only six percent of the patients with ongoing disc disease needed more surgery.


Hirokazu Ishihara, MD, et al. Adjacent Segment Disease after Anterior Cervical Interbody Fusion. In The Spine Journal. November/December 2004. Vol. 4. No. 6. Pp. 624-628.

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