Late sequelae of anterior decompression and fusion for cervical spondylotic radiculo - myelopathy

ABSTRACT

Twenty-seven patients with cervical spondylotic radiculomyelopathy were managed by anterior decompression and fusion and were followed up for five years to review late sequelae in the adjacent segment to the site of previous fusion. The main evident complication was recurrent radiculomyelopathy at a new level adjacent to the site of previous fusion [five cases], three cases of them developed on the third year, one case on the fourth year and the last case on the fifth year, these levels were symptoms free on the first fusion. The greatest incidence was at the inter-space between the fifth and the sixth and between the sixth and the seventh cervical vertebrae, these cases did not respond to non-operative management and were treated by another anterior cervical decompression and fusion. It was observed that symptomatic adjacent segment disease affected about one fifth of all patients within five years after anterior cervical decompression and fusion. A single level fusion involving the fifth or sixth cervical space and pre-existing radiologic evidence of degeneration at adjacent levels appear to be the greatest risk factor for a new disease, so it is recommended that all degenerated segments causing radiculopathy or myelopathy should be included in the anterior cervical fusion and the patients should be informed of the substantial possibility that a new disease will develop at an adjacent level over the long term