Cervical Spine Endplate Abnormalities & Association with Pain, Disability and Adjacent Segment Degeneration after Anterior Cervical Discectomy and Fusion

• Published in: Spine (Philadelphia, Pa. 1976)
• Main Authors: Harada, Garrett K, Alter, Kevin, Nguyen, Austin Q, Tao, Youping, Louie, Philip K, Basques, Bryce A, Galbusera, Fabio, Niemeyer, Frank, Wilke, Hans-Joachim, An, Howard S, Samartzis, Dino
• Format: Journal Article
• Language: English
• Published: United States 01.08.2020
• ISSN: 1528-1159
• DOI: 10.1097/BRS.0000000000003460

Retrospective cohort OBJECTIVE.: To determine how type, location, and size of endplate lesions on magnetic resonance imaging (MRI) may be associated with symptomatology and clinical outcomes after ACDF. Structural endplate abnormalities are important phenomena that remain understudied in the cervical spine. Anterior cervical discectomy and fusion (ACDF) is a common surgical treatment for degenerative disc disease; however, adjacent segment degeneration/disease (ASD) may develop. We performed a retrospective study with prospectively-collected data of patients who underwent ACDF. Charts were reviewed for preoperative sagittal MRI of the cervical spine. Endplate abnormalities were identified and stratified by type (atypical, typical), location, relation to operative levels, presence at the adjacent level, and size. These strata were assessed for association with presenting symptoms, patient-reported, and postoperative outcomes. Of 861 patients, 57.3% had evidence of endplate abnormalities, 39.0% had typical abnormalities, while 18.2% had atypical abnormalities. Mean duration of follow-up was 17.4 months. Patients with any endplate abnormality had greater odds of myelopathy irrespective of location or size, while sensory deficits were associated with atypical lesions (p = 0.016). Typical and atypical abnormalities demonstrated differences in patient-reported outcomes based on location relative to the fusion segment. Typical variants were not associated with adverse surgical outcomes, while atypical lesions were associated with ASD irrespective of size or location (p = 0.004), and reoperations, when a large abnormality was present at the proximal adjacent level (p = 0.025). This is the first study to examine endplate abnormalities on MRI of the cervical spine, demonstrating distinct risk profiles for symptoms, patient-reported, and surgical outcomes after ACDF. Patients with typical lesions reported worsening postoperative pain/disability, while those with atypical abnormalities experienced greater rates of ASD and reoperation. This highlights the relevance of a degenerative spine phenotypic assessment, and suggests endplate abnormalities may prognosticate clinical outcomes after surgery. 3.