New Classification for Clinically Symptomatic Adjacent Segment Pathology in Cervical Disc Disease

Area of Science:

• Spine surgery
• Neurosurgery
• Orthopedics

Background:

• Clinical adjacent segment pathology (CASP) is a frequent complication following cervical disc surgery.
• Existing classifications do not adequately address CASP in patients with congenital or degenerative cervical fusion.
• There is a need for a practical classification system for CASP.

Purpose of the Study:

• To develop a novel and practically applicable classification scheme for clinical adjacent segment pathology (CASP).

Main Methods:

• Retrospective analysis of 320 patients who underwent surgery for cervical disc prolapse.
• Follow-up of 316 patients for 3-11 years, with postoperative MRI analysis in 165 cases.
• Inclusion of patients with congenital and degenerative cervical fusion in the analysis.

Main Results:

• The overall frequency of CASP was 8.5% (27/316), with 1.9% requiring reoperation.
• CASP occurred in four patients with pre-existing congenital or degenerative fusion.
• A new classification system was developed, categorizing CASP into primary (congenital/degenerative fusion) and secondary (post-surgical) types, with subtypes based on symptoms and severity.

Conclusions:

• Symptomatic CASP requiring reoperation is infrequent.
• CASP can occur in patients with congenital or degenerative cervical fusion.
• The proposed classification and treatment strategy differentiate between CASP requiring surgery and that needing observation.