Adjacent segment degenerative disease: is it due to disease progression or a fusion-associated phenomenon? Comparison between segments adjacent to the fused and non-fused segments

Song, Kyung-Jin; Choi, Byung-Wan; Jeon, Taek-Soo; Lee, Kwang-Bok; Chang, Han

doi:10.1007/s00586-011-1864-9

Cited by 101 publications

(74 citation statements)

References 21 publications

(24 reference statements)

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“…Firstly, regarding the fixation area, adjacent-level failures occurred in patients who received fixation of ''O-T4'' or longer distance, which suggested that the long fusion might cause adjacent-level failures due to greater mechanical stress. In a similar way, Song et al [15,16] reported that fusion may increase mechanical stress at adjacent disc levels and lead to adjacent segment disease, and that multi-level fusion accelerated the severity of adjacent-level degeneration as compared to single-level fusion in degenerative cervical disease.…”

Section: Discussionmentioning

confidence: 87%

Adjacent-level failures after occipito-thoracic fusion for rheumatoid cervical disorders

Tanouchi¹,

Shimizu²,

Fueki³

et al. 2013

Eur Spine J

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Introduction The natural history of cervical spine lesions in rheumatoid arthritis (RA) is variable. We have actively performed occipito-thoracic fusion for severe destructive rheumatoid cervical disorders and reported its clinical results and complications. In our previous study, the most frequent complication was the adjacent-level failures caused by the fragile spine. The objective of this study was to determine risk factors for adjacent-level failures after occipito-thoracic fusion. Materials and Methods Subjects were 35 RA patients (31 females and 4 males) who underwent occipito-thoracic fusion using RRS Loop Spinal System Ò (Robert Reid Inc. Tokyo, Japan), and the incidence and characteristics of adjacent-level failures were investigated. Furthermore, the adjacent-level failures were divided into two types according to their levels, fracture at the lowest level of the fusion area and that at the level inferior to the fusion area, and the characteristics of each type were evaluated. Results and Conclusion Nine (26 %) of 35 patients suffered adjacent-level failures (10 vertebral fractures). Adjacent-level failures occurred when the distance of fixation was ''O-T4'' or longer. The long fusion might cause adjacentlevel failures due to greater mechanical stress. Seven fractures occurred at the lowest level of the fusion area, and all of them were cured without symptoms by conservative treatment. Three fractures occurred at the level inferior to the fusion area, and one of them needed additional surgery due to sudden paraplegia resulting from collapse of the adjacent vertebra. After occipito-thoracic fusion, burst fractures at the level inferior to the fusion area might cause sudden paraplegia, and therefore a careful observation should be required for patients with these fractures.

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Section: Discussionmentioning

confidence: 87%

Adjacent-level failures after occipito-thoracic fusion for rheumatoid cervical disorders

Tanouchi¹,

Shimizu²,

Fueki³

et al. 2013

Eur Spine J

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“…Adjacent-segment disease has been defined as the development of new radiculopathy or myelopathy of a motion segment adjacent to the site of a previous arthrodesis of the spine (either superior or inferior). 37,42,52,91,96,100 Because this is a clinical definition, it is often confused with a radiographic definition of adjacent segment degeneration in which disc degeneration is observed at adjacent motion segments to the fusion sites. However, studies have not demonstrated a clear correlation between the radiographic changes of adjacent segment degeneration and the clinical presentation of ASD.…”

Section: Cervical Deformity and Asdmentioning

confidence: 99%

“…There is overwhelming evidence for the existence of both clinical ASD and radiographic adjacent segment degeneration, but controversy remains about the origin of the ASD or degeneration. 37,47,71,91,96,100 Investigations of whether ASD is the natural course of the spine or if adjacent spinal fusion contributes directly to ASD are still being conducted in hopes of finding a solid explanation. However, biomechanical studies have shown results of possible mechanisms of ASD.…”

Section: Cervical Deformity and Asdmentioning

confidence: 99%

Cervical spine alignment, sagittal deformity, and clinical implications

Scheer

Tang

Smith

et al. 2013

SPI

591

567

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This paper is a narrative review of normal cervical alignment, methods for quantifying alignment, and how alignment is associated with cervical deformity, myelopathy, and adjacent-segment disease (ASD), with discussions of health-related quality of life (HRQOL). Popular methods currently used to quantify cervical alignment are discussed including cervical lordosis, sagittal vertical axis, and horizontal gaze with the chin-brow to vertical angle. Cervical deformity is examined in detail as deformities localized to the cervical spine affect, and are affected by, other parameters of the spine in preserving global sagittal alignment. An evolving trend is defining cervical sagittal alignment. Evidence from a few recent studies suggests correlations between radiographic parameters in the cervical spine and HRQOL. Analysis of the cervical regional alignment with respect to overall spinal pelvic alignment is critical. The article details mechanisms by which cervical kyphotic deformity potentially leads to ASD and discusses previous studies that suggest how postoperative sagittal malalignment may promote ASD. Further clinical studies are needed to explore the relationship of cervical malalignment and the development of ASD. Sagittal alignment of the cervical spine may play a substantial role in the development of cervical myelopathy as cervical deformity can lead to spinal cord compression and cord tension. Surgical correction of cervical myelopathy should always take into consideration cervical sagittal alignment, as decompression alone may not decrease cord tension induced by kyphosis. Awareness of the development of postlaminectomy kyphosis is critical as it relates to cervical myelopathy. The future direction of cervical deformity correction should include a comprehensive approach in assessing global cervicalpelvic relationships. Just as understanding pelvic incidence as it relates to lumbar lordosis was crucial in building our knowledge of thoracolumbar deformities, T-1 incidence and cervical sagittal balance can further our understanding of cervical deformities. Other important parameters that account for the cervical-pelvic relationship are surveyed in detail, and it is recognized that all such parameters need to be validated in studies that correlate HRQOL outcomes following cervical deformity correction.

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“…The present armamentarium that exist with the neuro spine surgeon includes minimally invasive disc volume reducing procedures, neural decompressive procedures, lumbar fusion procedures, disc arthroplasty and posterior dynamic stabilization. The motion preserving procedures claim the benefit of preventing adjacent segment disease [2].…”

Section: Discussionmentioning

confidence: 99%

Management of Low Back Pain - Call for an Integrated Interventional Approach

Vadhanan¹

2017

J Pain Relief

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Introduction: Using advanced imaging, neurophysiologic and precision diagnostic techniques spinal pain can be diagnosed in only 50 to 80% of the patients. 20 to 50% remain incorrectly diagnosed. Furthermore axial and periaxial pattern of pain from ligaments, muscles, intervertebral discs and facet joints overlap significantly. Therefore patients continue to suffer because of diagnostic dilemma and also pose a therapeutic challenge. Rarely does low back pain involve only a single pain generator, therefore it is unlikely that a single treatment, such as surgery will result in the best outcome for the majority of the causes of low back pain.

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Adjacent segment degenerative disease: is it due to disease progression or a fusion-associated phenomenon? Comparison between segments adjacent to the fused and non-fused segments

Cited by 101 publications

References 21 publications

Adjacent-level failures after occipito-thoracic fusion for rheumatoid cervical disorders

Adjacent-level failures after occipito-thoracic fusion for rheumatoid cervical disorders

Cervical spine alignment, sagittal deformity, and clinical implications

Management of Low Back Pain - Call for an Integrated Interventional Approach

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