European Spine Journal (2018) 27:1440–1446
Spondylolisthesis adjacent to a cervical disc arthroplasty does
not increase the risk of adjacent level degeneration
David Christopher Kieser
· Derek Thomas Cawley
· Cecile Roscop
· Simon Mazas
· Pierre Coudert
· Ibrahim Obeid
· Jean‑Marc Vital
· Vincent Pointillart
· Olivier Gille
Received: 18 September 2017 / Revised: 18 February 2018 / Accepted: 27 March 2018 / Published online: 31 March 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose To understand whether a spondylolisthesis in the sub-axial spine cranial to a cervical disc arthroplasty (CDA)
construes a risk of adjacent level disease (ALD).
Methods A retrospective review of 164 patients with a minimum 5-year follow-up of a cervical disc arthroplasty was per-
formed. 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
Results The 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.
Conclusions A 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.
Graphical abstract These slides can be retrieved under Electronic Supplementary Material.
1.Adjacent level disease
3.Cervical disc arthroplasty
A representative case of a single level C5/6 CDA with flexion views showing
adjacent level spondylolisthesisthat did not progress to ALD.
Take Home Messages
1. A pre-operatively identified mild spondylolisthesisin the sub-axial spine cranially
adjacent to a planned CDA is not a risk factor for ALD within five years.
2. Those with a degenerative spondylolisthesisare at higher risk of ALD (33%) than
those with a non-degenerative cause for their spondylolisthesis (11%).
3. Post-operative CDA alignment, ROM or induced spondylolisthesisdo not affect the
rate of ALD in those with an adjacent spondylolisthesis
Keywords Adjacent level disease · Proximal junctional failure · Junctional kyphosis · Cervical disc arthroplasty ·
Spondylolisthesis is deﬁned as an anterior (anterolisthesis)
or posterior (retrolisthesis) translation of the superior ver-
tebra on its inferior counterpart. It is commonly recognised
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s0058 6-018-5574-4) contains
supplementary material, which is available to authorized users.
Extended author information available on the last page of the article