To the Editor:
I commend the authors on their
efforts to classify and propose a probable cause of adjacent level
ossificationfollowing arthrodesis with an anterior cervical plate. The prevalence of ossification in their series was rather high-- about 59% of 118
cephalad and 29% of 100 caudal adjacent disc spaces. It would have been helpful if they had assesed the clinical outcomes as well. I have a few questions for the authors.
Degenerative changes occur as part of the natural history of
cervical spondylosis. After arhtrodesis, the unfused adjacent segments have
more stress. It is also seen that new symptoms that develop after fusion in
the adjacent disc levels resolve after Anterior cervical
plating and fusion (1). As the disease can progress either way, what is the rationale for performing surgery?
There is a chance of developing adjacent level ossification
after open surgery or after microscopic surgery. Are they an
indication of imminent disc lesion?
It has been found in the literature that at 2-years follow up non-
operative treatment gave good to excellent results for symptoms of
cervical radiculopathy (2).Also a conflicting report found no difference in
the rate of new
radiculopathy that develops at adjacent level in patients who had Anterior
cervical discectomy or Anterior cervical plating[ACP] with fusion (3).So we
are at cross roads as what to tell our patients and how much to
tell.Whether to go for conservative treatment or operative.
Finally, I would like to know whether the authors feel there a need to remove the posterior longitudinal ligament
in all cases while doing ACP with fusion.If yes,then what are the do's and
and dont's and how much does this influence the adjacent level ossification?
REFERENCES:
1.Hillbrand AS,Carlson GD,Palumbo MA,Jones PK, Bohlman HH.
Radiculopathy and myelopathy at segments adjacent to the site of a
previous anterior cervical arthrodesis.J. Bone Joint Surg Am 1999;81:519-
528.
2.Saal JS, Saal JA,Yurth EF.Nonoperative management of herniated
cervicalintervertebral disc with radiculopathy. Spine 1996;21:1877-1883.
3.Lunsford LD,Bissonette D,Janetta PJ,Sheptaak PE,Zorub DS.Anterior
surgery for Cervical disc disease Part 1:Treatment of lateral cervical
disc herniation in 253 cases.J Neurosurg 1980;53 :1-11.
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