However, it is unclear whether these radiographic changes signify clinical significance. Adjacent segment disease asd is a broad term encompassing many complications of spinal fusion, including listhesis, instability, herniated nucleus pulposus, stenosis, hypertrophic facet arthritis, scoliosis, and vertebral compression fracture. Adjacent segment disease after lumbar spine surgery part 2. Adjacentsegment disease after thoracic pedicle screw fixation. The prevalence of asd after cervical and lumbar fusion surgery has been reported to be upward of 30%. Adjacent level disease following lumbar spine surgery.
The incidence of adjacent segment disease requiring surgery. Nov 20, 2014 adjacent segment disease has become a common topic in spine surgery circles because of the significant increase in fusion surgery in recent years. Figure 1 this may raise the subject of adjacent instability in those patients in adjacent segment degeneration in a 55 year old female after a posterior fusion due to spinal stenosis. Adults who underwent lif or transforaminal lumbar interbody fusion tlif for adjacent segment disease were compared. Apr 01, 20 in a classic study of the natural history of cervical adjacent segment disease, hilibrand et al 5 reported that symptomatic adjacent segment disease occurred at a relatively constant incidence of. Various studies examined supra adjacent degeneration following lumbar fusion, but few focused on infra adjacent degeneration. Paraspinal lean muscle mass measurement using spine mri as a.
To identify factors which may be important in the occurrence of symptomatic adjacent segment disease asd. In the current retrospective study, the authors describe the midterm clinical and radiographic outcomes of consecutive patients with cervical degenerative disk disease who underwent bryan cervical disc medtronic sofamor danek, inc, memphis, tennessee replacement in their hos. Several clinical studies about degenerative change at the adjacent segments after anterior cervical fusion have been reported 17. And, no adjacent segment disease was reported in the patient operated with interspinous spacer.
They found symptomatic adjacent segment disease at a relatively constant incidence of 2. Of the 630 individuals participated in the study, 76 12. Cervical disc arthroplasty versus anterior cervical. Adjacent segment disease and back pain spineuniverse. Incidence of adjacent segment degeneration in cervical disc arthroplasty versus anterior cervical decompression and fusion metaanalysis of prospective studies. Adjacent segment disease in the lumbar spine following instrumented fusion radcliff et al. Adjacent segment degeneration asd is a longterm complication that can occur after thoracolumbar fusion surgery. Adjacent segment disease fusion at l34 and l45 for the. Adjacent segment degeneration following spinal fusion for degenerative disc disease.
The area of the cervical spine where most fusions occur c3c7 is adjacent to a highly mobile upper. Risk factors for adjacent segment disease development after. New progress in adjacent segment degenerationdisease liu. Oblique lumbar interbody fusion for adjacent segment. Adjacent segment disease adjacent segment disease symptoms. Anterior discectomy and fusion, adjacent segment disease, two levels, posterior, revision surgery. Moreover, the pooled data analysis showed a significant reduction in the incidence rate of adjacent segment disease asdis p 0. Oblique, lumbar interbody fusion, adjacent segment disease background adjacent segment disease asd is one of the most common complications of lumbar spine fusion 1. Adjacent segment disease after anterior cervical inter. Adjacent segment disease asdis has become a common topic in spine surgery circles because of the significant increase in fusion surgery in recent years and the development of motion preservation technologies that theoretically should lead to a decrease in this pathology. Anterior cervical diskectomy and fusion for adjacent segment. In this manuscript, we focus on the development in asd in patients who have undergone a prior anterior cervical discectomy and fusion acdf. Adjacent segment degenerationdisease asd has been generally accepted as a long.
Adjacent segment disease is a representative longterm complication after spinal. Adjacent segment disease in the lumbar spine following. Anterior discectomy and fusion, adjacent segment disease. Adjacent segment disease asd is a spinal disorder that may develop after spinal fusion eg, instrumentation, bone graft. To establish the real incidence of adjacent segment disease after fusion, and to identify the levels and predisposing factors for the pathology, as well as. Adjacent segment disease is the fusing of one or two levels in the spine due to increased stress at the remaining adjacent levels of the spine.
Given the number of spinal fusions performed annually, concerns have mounted over the potential for adjacent segment degeneration radiographic changes of degeneration at levels adjacent to a spinal fusion and adjacent segment disease development of new symptoms correlating with adjacent segment degeneration. One year postop adjacent segment disease of the lumbar spine. Risk factors for adjacent segment disease development. The purpose of this study was to assess the preoperative prevalence of adjacent adjacent segment disease segment degeneration in patients undergoing acdf. To identify risk factors for occurrence of symptomatic adjacent segment disease asd after posterior lumbar instrumentation surgery. Effectiveness of reoperations for adjacent segment disease. Adjacent segment disease asd is a condition that sometimes occurs after a spinal fusion surgery to join or lock two or more bones together, stopping the natural motion at that level. Adjacent segment disease asd is a broad term encompassing many complications of spinal fusion, including listhesis, instability, herniated nucleus pulposus, stenosis, hypertrophic facet. Primary spinal disease and surgical factors associated with an increased risk of. Adjacent segment degeneration and adjacent segment disease. One of the most enduring controversies of spine surgery has been the question of propagation of disc degeneration beyond a single disc level into other adjac. Just like lumbar fusions, patients who had fusion in the neck also had a 40% chance of needing a second surgery. Adjacent segment disease was defined as new radicular or myelopathic symptoms that developed 1a 1b 1c 1d 1e figure 1. Anterior cervical diskectomy and fusion for adjacent.
We can create a personalized treatment plan to help manage asd. Comparative chart of mean vas from preoperative period. In previous reports, the incidence rate of symptomatic ads was reported to be 4. Adjacent segment degeneration following spinal fusion for. Adjacent segment disease after anterior cervical discectomy. Oct 01, 20 the concept of adjacent segment disease is based in the hypothesis that specific spine interventions increase the likelihood of spinal degeneration relative to the natural rate. Adjacentsegment disease following twolevel axial lumbar. In the analysis of risk factors, a negative l1 plumb line was associated with a 5. Pdf adjacent level disease following lumbar spine surgery.
Mar 23, 2018 adjacent segment disease is an overarching general term to describe symptomatic changes to the adjacent level following lumbar fusions. T reatment of symptomatic adjacentsegment degeneration. Adjacent segment disease asd is a degenerative disc disease ddd that can result from pressure at spinal levels directly above or below the site of a former spinal fusion procedure. Adjacent segment disease this booklet provides general information on adjacent segment disease asd. Kaplanmeier analysis predicted a disease free rate of adjacent segments in 94. A 69yearold man developed 2level adjacent segment disease 4 years after primary surgery, and anterior cervical diskectomy and fusion. The adjacent levels then tend to degenerate at an accelerated rate because of the increased load and stress. The incidence of symptomatic adjacent segment disease asd after anterior cervical diskectomy and fusion acdf was reported as 2. Radiographs showing progressive changes after lumbar spinal fusion preoperatively a and 2 years b, 5 years c, and 9 years d postoperatively.
Despite its excellent efficacy, adjacent segment disease asd still occurs. Minimally invasive procedure reduces adjacent segment. Aim of this study is to analyze the utilization of percutaneous transforaminal endoscopic discectomy pted for the treatment of symptomatic asd, emphasizing basically in the postoperative course. Spinal instrumentation surgery is a common surgical procedure for treatment of various lumbar spinal disorders including spinal degenerative disease. Although asd is widely known to be a potential complication of spinal fusion, it can also be caused by natural degenerative changes that occur in the spine due to aging. There were no significant differences between the two groups in terms of. A rtigo o riginal o riginal a rticle a r ticulo o riginal. Congenital stenosis and adjacent segment disease in the. It is not meant to replace any personal conversations that you might wish to have with your physician or other member of your healthcare team. Asd is usually considered a relatively longterm complication, but earlyonset asd within 1 year after lif was also reported to be 0. In lumbosacral fusion, fusion extends to the sacrum, placing increased stress on the sacroiliac joint sij. Adjacent segment disease has been considered a late complication of spinal fusion. Update to the tretament of degenerative cervical disc disease. Oct 19, 2017 an alternative to fusion for adjacent segment disease the best way to protect all segments of the spine is to avoid fusion altogether.
Increased stress and motion on adjacent segments, increased forces and intradiskal pressure in adjacent disks, and increased loading on facet joints within unfused segments 7 10 have been postulated as causes of asd keywords. Adjacent segment disease after an anterior cervical discectomy and fusion certainly exists, but is still unclear if this is secondary to the natural history of the degenerative cervical spine, or whether it is secondary to increased stress causing the iatrogenic instability or degenerative disease at the adjacent spinal segments. Arthrodesis remains a common intervention for the surgical treatment of degenerative spinal disease. Pdf prevalence of adjacent segment disc degeneration in. Years of data from cervical spine procedures show the importance of retaining motion in the joints. Adjacent segment disease occurred after singlelevel acdf in 54% of cases, most commonly after c56 fusion 28%. Cervical asd can occur at a rate higher than degeneration from natural causes lee et al. Pdf was an effective surgical option for older patients with myelopathy developing in adjacent segments.
The authors conclude that adjacent segment disease is more a result of the natural history of cervical spondylosis than the presence of fusion. Risk of adjacentsegment disease requiring surgery after. Not all the information here will apply to your individual treatment or its outcome. The purpose of this study was to compare the clinical and radiological outcomes of repeat anterior and posterior decompression and fusion procedures for twolevel symptomatic asd. Based on recently proposed terminology, degeneration that develops at mobile. Incidence and risk factors of adjacent segment disease follo. Intermediate clinical outcome of bryan cervical disc. Adjacent segment disease asd constitutes a longterm complication of instrumented spinal fusion. The risk factors of early and lateonset adjacent segment. Adjacent segment disease asd is a wellrecog nized longterm consequence of lumbar interbody. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders. Accurate radiographic studies are important in the form of 3. Adjacent segment disease can be very problematic as the stress from everyday activities places increased stress on the nearby discs, leading to degeneration and damage of the once healthy surround discs. Confounding studies of asd is the observation in natural history studies that disk degeneration progresses even in 41% of asymptomatic individuals.
Advancesinorthopedics 5 0 1 2 3 4 5 6 7 8 9 10 preop early postop 6 months postop vas vas figure 4. However, in spite of achieving successful fusion in spinal surgery, a longterm followup after a solid fusion has revealed degenerative changes including segmental instability, spinal stenosis, intervertebral disc lesion, retrospondylolisthesis. It has generally been confirmed that fusion leads to a greater incidence of adjacent segment degeneration and disease, at least in short. Ap c and lateral a view 1 week after the operative procedure. Risk factors for predicting the need for additional. Following a fusion, that area of the spine typically becomes immobile which may cause abnormal loads to adjacent. Adjacent segment disease asd is a wellrecognized longterm outcome in patients with degenerative disease of the spine. Pdf adjacent segment degeneration following spinal.
Jul 28, 2014 adjacent segment disease asd is a broad term encompassing many complications of spinal fusion, including listhesis, instability, herniated nucleus pulposus, stenosis, hypertrophic facet. There appears to be an incidence of adjacent segment degeneration and disease after arthrodesis that may be related to natural degeneration or the adjacent fusion. Adjacent segment disease after anterior cervical inter body. The study demonstrated an annual incidence of approximately 2. The purpose of the current study was to determine the risk of asd requiring surgical treatment after short lumbar or lumbosacral fusion. However, a few clinical studies have specifically aimed to assess the incidence of adjacent segment disease asd after cda. Adjacent segment disease after posterior lumbar instrumentation. Adjacentlevel arthroplasty following cervical fusion.
Instrumented lumbar spine surgery is associated with an increased risk of adjacent segment disease asd. Adjacent segment disease in a patient with klippelfeil. Its described as any degeneration that develops at mobile segments above. Twolevel symptomatic adjacent segment disease asd is rarely reported, but remains a challenge after anterior cervical arthrodesis. Adjacent segment disease asdz is a potential complication following lumbar spinal fusion. The incidence of adjacent segment disease in the cervical spine is close to 3% without a significant statistical difference between surgical techniques fusion vs. Bendo, journalbulletin of the nyu hospital for joint diseases, year2007, volume65 1, pages 2936. Incidences of adjacent segment disease after cervical fusion were reported by hilibrand. Pdf risk factors for adjacent segment disease development. Several authors have argued that adjacent segment disease asd is part of the natural history of degenerative spinal disease 4 6 7 however, asd is a known complication of anterior cervical discectomy and fusion acdf and often times requires reoperation. This revision surgery can be an additional acdf or a posterior cervical fusion. Adjacent segment degeneration versus disease after lumbar. Degenerative changes develop on the discs and joints above or below the level where a previous surgery was performed.
There are, however, some authors who believe that adjacent segment degeneration is more a progression of the disease rather than a result of the fusion itself. Adjacent segment disease asd development is known to occur after anterior cervical discectomy and fusion acdf. As indicative above, numerous studies reported that various factors influence the occurrence of adjacent segment disease and results whether it is brought about due to trauma by surgery or. Etiologybased classification of adjacent segment disease. Original articlea original o adjacent segment disease in. Ultimately this can lead to the need for additional fusions, creating a larger locked vertebral segment and perpetuating a domino effect of. To study the relationship between index acdf levels and the location of asd development abovebelow, as well as the effect of fusion length on asd development. Risk factors for adjacent segment disease were found to be preexisting radiological signs of degeneration at the primary surgery 74% and bad sagittal profile the curve was bad after the primary anterior cervical decompression.
Acdf for adjacent segment disease were enrolled in the study. As indicative above, numerous studies reported that various factors influence the occurrence of adjacent segment disease and results whether it is brought about due to trauma by surgery or natural history is inconsistent. Spinal fusion surgeries use bone grafts andor hardware to permanently lock together two or more vertebrae for the purpose of making a section of the spine thought to be producing pain symptoms immovable. A case of adjacent segment disc herniation following a. Adjacent segment disease and spinal surgery with dr. Treatment of adjacent segment disease with percutaneous. T reatment of symptomatic adjacentsegment degeneration after. From the department of orthopedics, chinajapan union hospital of jilin university, changchun, china. New progress in adjacent segment degenerationdisease. New progress in adjacent segment degenerationdisease liu 2010. May 27, 2019 in order to decrease the risk of a patient developing adjacent segment disease after a fusion procedure the following steps are extremely important.
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