Which post-surgical complication is important to monitor after ACDF?

• A. Adjacent segment degeneration and pseudarthrosis
• B. Wound infection only
• C. Acute disc herniation
• D. Dural tear

Answer: (A)

After ACDF, the long-term success depends on both a solid fusion and how the neighboring spinal levels adapt to the change in biomechanics. The most important issues to monitor over time are adjacent segment degeneration and pseudarthrosis. The fused segment shifts stress to the levels above and below, which can hasten degeneration at those adjacent levels and potentially cause new neurological symptoms years after the surgery. Pseudarthrosis, or failure of the fusion to unite, undermines stability at the operated level and can lead to ongoing pain or the need for revision. These problems reflect the durability and overall outcome of the fusion, making them key targets for ongoing follow-up. While wound infection, acute disc herniation, and dural tears are important perioperative concerns, they are typically addressed in the immediate postoperative period rather than as ongoing post-surgical monitoring priorities.