Adjacent segment disease following cervical spine surgery | Treatment options

Adjacent segment disease following neck surgery

Ross Hauser, MD

As I have discussed in numerous pages on this website, not only has it been shown that spinal fusion, whether lumbar fusion or cervical fusion,  can be an inappropriate treatment for many patients, worse off, the fusion can do much more harm than good.

One area of harm is adjacent segment disease. This is a failed surgery condition in which the the adjacent vertebrae to the fused section rapidly degenerates because of newly created surface tension and stress by the immobility of the fused segment.

If you have questions about ACDF: Anterior Cervical Discectomy and Fusion You can get help and information from our Caring Medicl staff.

Opinion: Anterior Cervical Discectomy and Fusion

When your cervical vertabrae are fused to limit cervical instability and related symptoms, the force and energy in your neck movements are gong to be transferred transferred to the vertebrae below the fusion and above the fusion. In many patients all that was done was a transfer of the problem of excessive pressures to the vertebrae to areas below it and above it the fusion so that’s why people cervical fusion is inevitably a year to 3 years later you get the symptoms back they can even be worse

Understanding Anterior Cervical Discectomy and Fusion surgery, risks, complications and inappropriateness.

Doctors at the University of Alberta note: “Cervical spine clinical adjacent segment pathology has a reported 3% annual incidence and 26% ten-year prevalence. Its pathophysiology remains controversial, whether due to mechanical stress of a fusion segment on adjacent levels or due to patient propensity to develop progressive degenerative change.”1

Simply in the above research, within 10 years, 1 in 4 patients are at risk of clinical adjacent segment disease.

ACDF: Anterior Cervical Discectomy and Fusion

In another study focusing on the same problem, doctors in writing in the medical journal Neurosurgical Focus reported on neck pain from adjacent-level disc degeneration following cervical fusion:

Say the doctors:

Adjacent-level disc degeneration is a condition that poses a major treatment dilemma when it becomes symptomatic. The potential application of cervical arthroplasty (cervical disc replacement) to preserve motion in the affected segment is not well documented, with few studies in the literature.

(However) artificial cervical disc replacement in patients who have previously undergone cervical fusion surgery appears to be safe, with encouraging early clinical results based on this small case series, but more data from larger numbers of patients with long-term follow-up are needed. Arthroplasty may provide an additional tool for the management of post-fusion adjacent-level cervical disc disease in carefully selected patients.2

Many of the patients we see at Caring Medical report to us that they are often offered “just one more surgery.” In this case, disc replacement may help some patients you already had a failed surgery. In our opinion the problems of failed cervical fusion is greater than reported. Many people just live with the problems rather than go back to a surgeon. If pain and problems are not reported, despite patient suffering, the surgery is deemed a success.

Cervical Total Disc Replacement

In selected patients, cervical disc replacement may be beneficial. The above study warns however that these patients, for who the surgery may be beneficial, need to be carefully selected because of the surgery’s challenges.

Here we are back to the “one more surgery” thinking. In new research doctors looked at the  difference in rate of reoperation for adjacent segment disease between anterior cervical decompression and fusion and total disc replacement.

The average reoperation rate for adjacent segment disease in patients who received a total disc replacement was 3.1% which was lower than the reoperation rate of 6.0% in the adjacent segment disease caused by fusion group. However, further studies and follow-up data are still needed to determine if cervical total disc replacement preserves adjacent segment motion more efficiently than the natural history of the disease, and if it will be a durable option when compared to anterior cervical decompression and fusion.3

Cervical Prolotherapy

Ask us your questions about this article

1 Jack A, Hardy St-Pierre G1, Nataraj A. Adjacent Segment Pathology: Progressive Disease Course or a Product of Iatrogenic Fusion? Can J Neurol Sci. 2017 Jan;44(1):78-82. doi: 10.1017/cjn.2016.404. [Pubmed]

2 Rajakumar DV, Hari A, Krishna M, Konar S, Sharma A. Adjacent-level arthroplasty following cervical fusion. Neurosurg Focus. 2017 Feb;42(2):E5. doi: 10.3171/2016.11.FOCUS16412. [Pubmed]

3 Chang KE, Pham MH, Hsieh PC.  Adjacent segment disease requiring reoperation in cervical total disc arthroplasty: A literature review and update. J Clin Neurosci. 2017 Mar;37:20-24. doi: 10.1016/j.jocn.2016.10.047. Epub 2016 Nov 16. [Pubmed]

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