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Updated: Jan 23, 2026

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Does index level sagittal alignment determine adjacent level disc height loss?

Ryan Snowden1, Justin Miller1, Tome Saidon2

  • 11Indiana Spine Group, Carmel (Indianapolis), Indiana; and.

Journal of Neurosurgery. Spine
|June 22, 2019
PubMed
Summary
This summary is machine-generated.

Cervical spine surgery outcomes show that neither pre-operative nor post-operative sagittal alignment impacts adjacent segment pathology. Time is the only significant factor influencing radiographic adjacent segment pathology (RASP) after cervical total disc arthroplasty (TDA) or anterior cervical discectomy and fusion (ACDF).

Keywords:
ACDFBryan disc arthroplastyadjacent level degenerationadjacent segment pathologyanterior cervical discectomy and fusiondeformityprospectivesagittal alignment

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Area of Science:

  • Spine Surgery
  • Orthopedics
  • Radiographic Analysis

Background:

  • Adjacent segment pathology (RASP) is a concern following cervical spine surgery.
  • Understanding factors influencing RASP is crucial for long-term patient outcomes.

Purpose of the Study:

  • To compare the effect of index level sagittal alignment on cephalad RASP.
  • To evaluate RASP in patients undergoing cervical total disc arthroplasty (TDA) versus anterior cervical discectomy and fusion (ACDF).

Main Methods:

  • Retrospective analysis of prospectively collected radiographic data from 79 patients.
  • Inclusion of patients from a multicenter FDA investigational device exemption trial.
  • Measurement of index level Cobb angle and disc height/AP distance ratio over up to 7 years post-surgery.

Main Results:

  • Postoperative lordosis was greater in ACDF patients compared to TDA patients (p = 0.002).
  • Postoperative kyphotic Cobb angle was more likely in TDA patients (p = 0.01).
  • A significant decrease in disc height/AP ratio occurred over time (p = 0.035), independent of alignment or surgery type.

Conclusions:

  • Preoperative and postoperative sagittal alignment do not influence RASP at 7-year follow-up.
  • Time is the sole significant factor identified as affecting RASP in this cohort.
  • Findings suggest that sagittal alignment may not be a primary predictor of long-term adjacent segment pathology after TDA or ACDF.