• David Christopher Kieser, Derek Thomas Cawley, Cecile Roscop, Simon Mazas, Pierre Coudert, Louis Boissiere, Ibrahim Obeid, Jean-Marc Vital, Vincent Pointillart, and Olivier Gille.
• Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury School of Medicine, University of Otago, Christchurch, New Zealand. kieserdavid@gmail.com.
• Eur Spine J. 2018 Jun 1; 27 (6): 1440-1446.

PurposeTo understand whether a spondylolisthesis in the sub-axial spine cranial to a cervical disc arthroplasty (CDA) construes a risk of adjacent level disease (ALD).MethodsA retrospective review of 164 patients with a minimum 5-year follow-up of a cervical disc arthroplasty was performed. Multi-level surgeries, including hybrid procedures, were included. Multiple implant types were included. The two inter-vertebral discs (IVD) cranial of the CDA were monitored for evidence of radiologic degeneration using the Kettler criteria.ResultsThe rate of ALD in CDA found in this series was 17.8%, with most affecting the immediately adjacent IVD (27.4 and 7.6%, respectively p = 0.000). Pre-operative mild spondylolisthesis adjacent to a planned CDA was not found to be a risk factor for ALD within 5 years. Those with a degenerative spondylolisthesis are at higher risk of ALD (33%) than those with a non-degenerative cause for their spondylolisthesis (11%). Post-operative CDA alignment, ROM or induced spondylolisthesis do not affect the rate of ALD in those with an adjacent spondylolisthesis. Patients with ALD experience significantly worse 5-year pain and functional outcomes than those unaffected by ALD.ConclusionsA pre-operatively identified mild spondylolisthesis in the sub-axial spine cranially adjacent to a planned CDA is not a risk factor for ALD within 5 years. These slides can be retrieved under Electronic Supplementary Material.

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