Prospective cohort study of 374 patients followed up to 21 years after anterior cervical arthrodesis. Defines the incidence, prevalence, and risk factors for symptomatic adjacent-segment disease — new radiculopathy or myelopathy at a motion segment immediately adjacent to a prior fusion. Answers the question: how often does this happen, to whom, and when?
Tell every patient before anterior cervical fusion: there is approximately a 1-in-4 chance of developing new radiculopathy or myelopathy at an adjacent level within 10 years, requiring potential reoperation.
When you review preoperative MRI and see grade III or IV degeneration at a level adjacent to your planned fusion — especially at C5-6 or C6-7. That level is at high risk for rapid symptom onset (under 2 years). Strongly consider including it in the initial arthrodesis if clinical findings support it.
The counterintuitive finding here drives modern practice: do not stage operations by fusing one level and watching the others. Addressing all symptomatic, compressive levels in a single procedure reduces adjacent-segment disease risk, because multilevel constructs end adjacent to the naturally lower-risk C2-3 or C7-T1 segments.
This paper is the foundational reference for cervical disc arthroplasty trials. The Prestige and Bryan disc studies used the 2.9%-per-year benchmark to test whether motion preservation reduces adjacent-segment disease rates.
Prospective cohort study of 374 patients followed up to 21 years after anterior cervical arthrodesis. Defines the incidence, prevalence, and risk factors for symptomatic adjacent-segment disease — new radiculopathy or myelopathy at a motion segment immediately adjacent to a prior fusion. Answers the question: how often does this happen, to whom, and when?
Tell every patient before anterior cervical fusion: there is approximately a 1-in-4 chance of developing new radiculopathy or myelopathy at an adjacent level within 10 years, requiring potential reoperation.
When you review preoperative MRI and see grade III or IV degeneration at a level adjacent to your planned fusion — especially at C5-6 or C6-7. That level is at high risk for rapid symptom onset (under 2 years). Strongly consider including it in the initial arthrodesis if clinical findings support it.
The counterintuitive finding here drives modern practice: do not stage operations by fusing one level and watching the others. Addressing all symptomatic, compressive levels in a single procedure reduces adjacent-segment disease risk, because multilevel constructs end adjacent to the naturally lower-risk C2-3 or C7-T1 segments.
This paper is the foundational reference for cervical disc arthroplasty trials. The Prestige and Bryan disc studies used the 2.9%-per-year benchmark to test whether motion preservation reduces adjacent-segment disease rates.