Iatrogenic contributions to cervical adjacent segment pathology: review article
Haruki Ueda1, Russel C Huang2, Darren R Lebl2
1Hospital for Special Surgery Spine Care Institute, Weill Cornell College of Medicine, New York, NY 10065 USA ; Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Summary
Anterior cervical discectomy and fusion (ACDF) may accelerate natural cervical spine degeneration. Iatrogenic factors, not just aging, appear significant in adjacent segment pathology after ACDF surgery.
Area of Science:
- Spine surgery
- Degenerative spine disease
- Biomedical engineering
Background:
- Anterior cervical discectomy and fusion (ACDF) is a common spinal procedure.
- Adjacent segment pathology (ASP) is a known complication that can negatively impact surgical outcomes.
- The degree to which ACDF accelerates natural cervical spine degeneration remains unclear.
Purpose of the Study:
- To review current evidence on adjacent segment pathology (ASP) after ACDF.
- To analyze biomechanics, natural history, and postoperative factors related to ASP.
- To compare ACDF with total disc replacement (TDR) regarding ASP.
Main Methods:
- Systematic review of published literature.
- Searched Google Scholar and PubMed for "adjacent disc pathology" and "cervical spine".
- 37 articles were selected for analysis.
Main Results:
- Biomechanical and clinical evidence suggests ACDF may accelerate natural cervical spine aging.
- Adjacent segment pathology (ASP) is likely an iatrogenically accelerated aging process.
- Current randomized controlled trials (RCTs) may lack the statistical power to definitively prove this acceleration.
Conclusions:
- Iatrogenic factors significantly contribute to adjacent segment pathology (ASP) following ACDF.
- Further research is needed to fully elucidate the role of ACDF in accelerating spinal degeneration.