Research

Purpose: Complete data on the incidence of cervical spondylosis and neck pain after long fusion to the sacrum does not exist. The goal was to determine the incidence of radiographic cervical spondylosis and neck pain in this population.

Methods. Forty-eight adult patients who had primary posterior spinal fusion from the sacrum to T10 or higher with minimum five year follow-up completed cervical pain and functional questionnaires. Follow-up cervical AP, lateral, flexion and extension radiographs were obtained and evaluated for loss of disc height, sclerosis, listhesis and osteophyte formation.
Results. Average age at surgery was 47 years (range 18 - 72). Average follow-up was 8.5 years (range 5 – 26). All patients displayed cervical degeneration at three (3% of patients), four (16% of patients) or five (81% of patients) levels. Degenerative changes were mild in 13%, moderate in 65% and severe in 23%. Daily neck pain, shoulder pain and radicular symptoms were noted in 33%, 17% and 19% of patients, respectively. Severity of radiographic degeneration and symptoms were not correlated with each other, nor were they individually correlated with years of follow-up or upper end vertebra of fusion. Functional ability decreased with increased degenerative changes, neck pain and radicular symptoms (statistically significant, p<0.05).

Conclusions. This study reports a higher incidence of cervical spondylosis and symptoms compared to the general population. This suggests that effects of long fusion to the sacrum are coupled to the cervical spine and are radiographically and functionally significant. Neither radiographic degeneration nor patient symptomatology was related to length of follow-up or length of fusion.