The Effect of Plating on Adjacent Segments in Anterior Cervical Discectomy and Fusions in Patients with Degenerative Spine Disease: A Retrospective Cohort Study

Johan L. Heemskerk, Carlos Perez Vega, Ricardo A. Domingo, Kent R. Richter, Reed Richter, Tito G. Vivas-Buitrago, Matthew T. Neal, Alfredo Quinones-Hinojosa, Kingsley Abode-Iyamah

Research output: Contribution to journalArticlepeer-review


Introduction: Plate distance is correlated with an increased incidence of adjacent segment pathologies (ASP). However, a correct plate-to-disk distance >5 mm is often not achieved. Therefore, this study aimed to quantify the effect of short plate-to-disk distance on the development of ASP using epidemiological measures in patients with cervical degenerative spine disease undergoing single-level anterior cervical discectomy and fusion (ACDFs). Methods: Medical records of all patients with cervical degeneration undergoing single-level ACDF with plating (between January 2015 and December 2017), and a follow-up of at least 1 year, were reviewed retrospectively. Radiologic and clinical outcomes were assessed preoperatively, postoperatively, and at last follow-up. The plate-to-adjacent disk distance was measured, and epidemiological measures were calculated to quantify the risk on adjacent-level ossification development (ALOD) and adjacent segment degeneration (ASD). Results: Thirty-eight (47.5%) of the 80 patients developed ALOD, and 12 (15.0%) developed ASD after a 2-year followup. The incidence of ALOD was significantly lower if the plate was >5 mm away from the adjacent disk space compared to <5 mm (cranial adjacent segment, 22.5% vs. 51.3% [P=0.010] and caudal, 21.4% vs. 47.8% [P=0.029]). A correct plate-to-disk distance resulted in a relative risk reduction of 57.2% for the cranial segment and 56.0% for the caudal segment, with a number needed to treat of 4. The ASD was only observed in the cranial adjacent segments, and a correct plate-to-disk distance resulted in a relative risk reduction of 32.1% and a number needed to treat of 18. Conclusions: Only four patients need to be treated with a correct plate-to-disk distance to avoid one case of ALOD. Therefore, it is advisable to keep the plate at a distance >5 mm away from the adjacent disk.

Original languageEnglish (US)
Pages (from-to)350-357
Number of pages8
JournalSpine Surgery and Related Research
Issue number4
StatePublished - 2022


  • ACDF
  • adjacent segment degeneration
  • adjacent segment pathology
  • adjacent-level ossification development
  • ALOD
  • anterior cervical discectomy and fusion
  • ASD
  • degenerative cervical spine disease

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this