Does the extent of soft tissue dissection and location of screws in anterior cervical discectomy and fusion impact the development of the adjacent segment degeneration? A prospective short-term radiological analysis.

Abstract

Background: Cervical degenerative disc disease is a common condition in neurosurgical practice. Elimination of a motion segment through fusion causes the load shift to the adjacent levels leading to disc degeneration. Our hypothesis is that by avoiding excessive dissection of the prevertebral soft tissue and placing anchoring screws away the adjacent endplate, we can reduce the load bearing and degeneration rate.

Methods: This is a prospective randomized control study. The study included 30 consecutive cases requiring single level ACDF, 15 each in conservative and minimal dissection group. MRI evidence of disc degeneration was assessed according to Matsumoto MRI grading system.

Results: No significant role of age on ASD was noted (P=0.26). ASD was worse in females than males especially at the inferior level (P=0.035). ASD was noted to be higher when the patients were operated at C5-6 level (P=0.026). The reduction in VAS was 5.933 in the minimal dissection group which was significantly better than the conventional surgery group (5.14) (P=0.023). The increase in degeneration score was 0.97 and 0.6 at superior and inferior levels, respectively, in the conventional group and 0.13 and 0.34 in minimal dissection group.

Conclusions: The minimal soft tissue dissection for single level ACDF with PEEK cage placement appears to have reducing rate of ASD compared to conventional ACDF. Minimal soft tissue dissection has better postoperative VAS scores.