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Adjacent segment disease following cervical spine surgery
1Mount Sinai School of Medicine, New York, NY, USA.
The Journal of the American Academy of Orthopaedic Surgeons
|January 3, 2013
Summary
Cervical spine fusion surgery can lead to adjacent segment disease. While artificial disk replacement aims to preserve motion, studies show it does not significantly reduce this complication compared to fusion.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Disorders
Background:
- Cervical spine surgery includes fusion and nonfusion techniques.
- Anterior cervical diskectomy and fusion (ACDF) is a prevalent procedure.
- Adjacent segment disease is a significant clinical concern following cervical fusion.
Purpose of the Study:
- To evaluate the effectiveness of different cervical spine surgical procedures in preventing adjacent segment disease.
- To compare fusion, nonfusion, and artificial disk replacement outcomes regarding adjacent segment disease.
Main Methods:
- Review of clinical trials and follow-up studies on cervical spine surgery outcomes.
- Analysis of adjacent segment disease incidence rates across various surgical approaches.
Main Results:
- Adjacent segment cervical disease affects approximately 3% of patients annually, with a 25% 10-year incidence post-fusion.
- Nonfusion procedures (anterior diskectomy, posterior foraminotomy) do not lower adjacent segment disease rates compared to ACDF.
- Artificial disk replacement has not demonstrated a significant reduction in adjacent segment disease compared to fusion in clinical trials.
Conclusions:
- Current evidence suggests that neither nonfusion procedures nor artificial disk replacement consistently reduce adjacent segment disease compared to traditional ACDF.
- Further research may be needed to identify truly motion-sparing alternatives that mitigate adjacent segment disease risk.
