Understanding C5-C6 ACDF Surgery and Osteoarthritis

The term ostenarthritis refers to the degeneration of a joint, typically due to long-term stress from movement. In the context of the spine, osteoarthritis predominantly affects the regions that move the most, such as the lower cervical and lumbar areas, with much less prevalence in the relatively immobile thoracic region. As we age and lose spinal mobility at certain levels, adjacent levels have to take on more movement and are consequently more prone to osteoarthritis.

One common method of addressing issues caused by spinal degeneration, such as a herniated disc, is a cervical Anterior Cervical Discectomy and Fusion (ACDF) surgery, particularly for the C5-C6 vertebrae. This procedure involves fusing two adjacent vertebrae to stabilize them and alleviate pain. However, the fusion can lead to changes in the adjacent vertebrae, a condition known as adjacent level disease (ALD).

The Risk of Adjacent Level Disease

Adjacent level disease (ALD) is a condition where the adjacent vertebrae develop osteoarthritis after a cervical fusion surgery, such as ACDF. A 2010 study found that the annual risk of developing ALD after C5-C6 ACDF surgery is approximately 2.9 cases per year, which means that more than 25 cases of ALD can develop over a 10-year period.

ALD occurs because the adjacent, non-fused vertebrae have to take on more movement and stress. This increased load can cause degeneration at the adjacent levels, leading to osteoarthritis. The adjacent levels may already be damaged before the surgery, but the fusion can exacerbate the issue by reducing mobility and potentially increasing the stress on these areas.

Advantages of Artificial Disc Replacement

To mitigate the risk of ALD, some surgeons opt for artificial disc replacement surgery instead of ACDF. Unlike fusion, which permanently immobilizes the vertebrae, artificial disc replacement maintains mobility at the surgical level. A recent study involving 384 patients found that even 5 years post-surgery, the adjacent discs showed no significant change in average motion compared to pre-surgical baseline measurements.

The conclusion of this study: “Proximal and distal adjacent discs showed no significant change in average motion 5 years after surgery compared to baseline.” This suggests that maintaining mobility at the surgical level can help prevent the progression of ALD and preserve the health of the adjacent vertebrae.

Controversies and Uncertainties

While the risks of ALD are well-documented, the precise causes of ALD are still not entirely clear. Some experts believe that ALD can occur due to pre-existing damage in the adjacent levels, while others hypothesize that the fusion itself can lead to increased stress and degeneration. However, there is no definitive answer, and more research is needed to understand the underlying mechanisms.

It is important for patients and healthcare providers to consider these factors when deciding on the best course of treatment for cervical spine issues. While ACDF surgery can provide long-term relief from symptoms, it also carries the risk of ALD. On the other hand, artificial disc replacement may provide better long-term outcomes by preserving spinal mobility.

Consulting with a specialist in spinal surgery and thoroughly discussing the risks and benefits of different surgical options is essential for making an informed decision.