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Chao-Hung Kuo, Wen-Cheng Huang, Jau-Ching Wu, Tsung-Hsi Tu, Li-Yu Fay, Ching-Lan Wu and Henrich Cheng

-grade spondylolisthesis. 3 , 11–13 However, few reports have addressed the true incidence of adjacent-segment degeneration (ASD) after these spinal surgeries. The pathological process observed at the spinal disc adjacent to the level that was treated with arthrodesis is regarded as ASD. Owing to advances in image technology, asymptomatic ASD can be identified by abnormal findings on radiological examinations; these findings include disc degeneration, segmental instability, or spinal stenosis and are termed “radiological ASD.” These radiological ASDs can be completely free of symptoms

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Tsung-Hsi Tu, Chao-Hung Kuo, Wen-Cheng Huang, Li-Yu Fay, Henrich Cheng and Jau-Ching Wu

A nterior cervical discectomy and fusion (ACDF) has been the standard surgical treatment for patients with cervical disc herniation or spondylosis causing intractable radiculopathy or myelopathy. Although symptom relief has been highly satisfactory after ACDF, there has also been adjacent-segment degeneration (ASD) that requires a secondary ACDF or other reoperation. 32 These cases of ASD may be attributable to increased load and compensatory motion after arthrodesis in ACDF. Cervical disc arthroplasty (CDA) was therefore designed to preserve segmental mobility

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Tsung-Hsi Tu, Jau-Ching Wu, Wen-Cheng Huang, Wan-Yuo Guo, Ching-Lan Wu, Yang-Hsin Shih and Henrich Cheng

F or decades, ACDF has been regarded as the “gold standard” of surgical intervention in treating cervical spondylosis and disc disease, producing excellent clinical outcomes. 4 , 5 , 10 , 14 Recently, there has been an emerging option of TDR, which is designed to preserve segmental motion and theoretically prevent ASD. 26 , 30 Whether ASD is a consequence of ACDF remains debatable. Several studies have shown that fusion of spinal motion segments alters cervical spinal biomechanics of the unfused adjacent levels. 7 , 8 , 17 , 33 , 36 Accelerated

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Peng-Yuan Chang, Hsuan-Kan Chang, Jau-Ching Wu, Wen-Cheng Huang, Li-Yu Fay, Tsung-Hsi Tu, Ching-Lan Wu and Henrich Cheng

, but has also been associated with increased risks for CSM, spinal cord injury (SCI), transient neurapraxia, SCI in athletes, and adjacent-segment diseases (ASDs) after anterior cervical discectomy and fusion (ACDF). 2 , 3 , 11 , 17 , 25 , 27–31 , 33 , 35 , 36 The application of cervical disc arthroplasty (CDA) in the treatment of cervical degenerative disc diseases (DDDs) has been proven by multiple FDA Investigational Device Exemption (IDE) trials to be a safe and effective alternative to conventional fusion surgery, i.e., ACDF. However, there have been scarce data

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Chun-Hao Wang, Peng-Yuan Chang, Hsuan-Kan Chang, Jau-Ching Wu, Wen-Cheng Huang, Li-Yu Fay, Tsung-Hsi Tu, Ching-Lan Wu and Henrich Cheng

). Although the radiopaque portions of both devices look similar on lateral radiographs, the CAD provides no spring force at the most-anterior (ventral) aspect of the device. Furthermore, the authors state in their conclusion that the potential advantages of the DCI over anterior cervical discectomy and fusion (ACDF) and cervical total disc replacement include minimizing “the development of ASD [adjacent-segment disease].” We concur with the authors that the presence of only 1 case of symptomatic ASD at 24 months after implantation of a DCI is encouraging, compared to

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Tsung-Hsi Tu, Chu-Yi Lee, Chao-Hung Kuo, Jau-Ching Wu, Hsuan-Kan Chang, Li-Yu Fay, Wen-Cheng Huang and Henrich Cheng

to assess and identify heterotopic ossification (HO) formation as described in previous studies. 37 , 41 , 42 Adjacent-segment degeneration (ASD) was assessed using the grading system adapted from Gore, and the presence of any of the following changes—anterior/posterior osteophyte, decreased disc height, and endplate sclerotic change—was regarded as ASD. 20 All quantitative radiographic measurements were performed on the SmartIris Imaging System (Taiwan Electronic Data Processing Co.) and interpreted independently by radiologists and neurosurgeons. FIG. 1

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Li-Yu Fay, Peng-Yuan Chang, Jau-Ching Wu, Wen-Cheng Huang, Chun-Hao Wang, Tzu-Yun Tsai, Tsung-Hsi Tu, Hsuan-Kan Chang, Ching-Lan Wu and Henrich Cheng

40 17 (73.9) 23 (48.9)   Yes 30 6 (26.1) 24 (51.1) * Indicates statistical significance, p < 0.05. There were 3 patients (4.3%) who had partial facet resection (medial one-third to decompress the lateral recess) scrutinized by comparison of the pre- and postoperative CT scans. Furthermore, there was no correlation between partial resection and rate of facet arthrodesis (p = 0.435) ( Table 4 ). TABLE 4. Correlation between facet resection, ROM, and ASD and facet arthrodesis * Characteristic Facet Arthrodesis p

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Li-Yu Fay, Wen-Cheng Huang, Chih-Chang Chang, Hsuan-Kan Chang, Tzu-Yun Tsai, Tsung-Hsi Tu, Ching-Lan Wu, Henrich Cheng and Jau-Ching Wu

instability. However, there are multiple concerns about adjacent-segment degeneration (ASD) after lumbar fusion. 1 , 2 , 10 , 17 , 18 , 27 Since DDS is another option to stabilize the spine and preserve the limited motion in the degenerative spine, theoretically it could lower the chances of ASD. We conducted studies to compare lumbar fusion with dynamic stabilization with an average follow-up of more than 2 years. 14 , 15 Kuo et al. first examined 86 patients with L4–5 spondylolisthesis and demonstrated that the clinical and radiological outcomes of DDS were similar to

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Chao-Hung Kuo, Peng-Yuan Chang, Jau-Ching Wu, Hsuan-Kan Chang, Li-Yu Fay, Tsung-Hsi Tu, Henrich Cheng and Wen-Cheng Huang

-Segment Disease The incidences of adjacent-segment disease (ASD) were not significantly different between the DDS and MI-TLIF groups (23.4% vs 31.8%, p = 0.62). After a meticulous review of postoperative image evaluations, 17 22 patients (15 and 7 patients from the DDS and MI-TLIF groups, respectively) were found to have radiological evidence of ASD (e.g., loss of disc height, disc degeneration/herniation, instability, listhesis, and hypertrophic facet arthritis) during the study period ( Table 3 ). Although none of the patients were symptomatic or have had any clinical

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Yu-Wen Cheng, Peng-Yuan Chang, Jau-Ching Wu, Chih-Chang Chang, Li-Yu Fay, Tsung-Hsi Tu, Wen-Cheng Huang and Henrich Cheng

standard posterior lumbar interbody fusion (PLIF) for L5–S1 spondylosis. They concluded that the incidence of adjacent-segment disease (ASD) 4 years after surgery was similar in patients treated with PDS and those treated with PLIF. Also, the authors found pre-existing disc degeneration at L4–5 to be an independent risk factor for ASD detected radiographically later on. Thus, the authors made the statement that PDS is feasible for L5–S1 spondylosis and pre-existing ASD does not necessitate any additional treatment, only observation, in the absence of clinical symptoms or