Methodology for the systematic reviews on an adjacent segment pathology.

Area of Science:

• Spinal surgery outcomes and adjacent segment pathology (ASP).
• Evidence-based medicine and systematic review methodologies.
• Clinical consensus development and guideline formulation.

Background:

• Adjacent segment pathology (ASP) is a significant concern following spinal surgery.
• Existing literature lacks standardized classification and clear risk factor identification for ASP.
• Systematic reviews and expert consensus are crucial for managing ASP risks.

Purpose of the Study:

• To outline the systematic search and analytical methods for adjacent segment pathology (ASP) literature.
• To describe the process of developing consensus statements and clinical recommendations for ASP.
• To inform clinicians on managing patients at risk of ASP and guide future research.

Main Methods:

• Systematic literature search and critical review of English-language articles on ASP.
• Screening articles using a priori criteria and assessing evidence strength (modified GRADE).
• Formulating consensus statements and recommendations via a modified Delphi process.

Main Results:

• 3382 articles screened; 127 included for analysis on 14 ASP topics.
• Established consensus definitions for radiographical ASP (RASP) and clinical ASP (CASP).
• Identified key risk factors, annual/5/10-year risks of ASP, and potential impact of surgical techniques.

Conclusions:

• Systematic reviews and expert consensus provide a foundation for understanding and managing ASP.
• The methods described facilitate the development of evidence-based clinical recommendations for ASP.
• Further research is needed, particularly on the treatment of cervical and lumbar ASP.