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Cervical Adjacent Segment Disease

Adjacent segment disease is a condition sometimes affecting a disc next to a fused segment. The theory is that the motion which has been eliminated at a spinal segment by a fusion, now has to be performed by the discs above and below the fusion. So, these segments have to move more than before the fusion. This could result in more stress placed on these segments and cause degeneration.

Is Adjacent Segment Disease something most Spine Specialists believe exists?

Spine specialists have debated this issue for a long time. One school of thought believes that in fact the stress on the discs next to a fusion can accelerate their degeneration. Another school of thought believes that these discs will naturally degenerate since the same thing had happened at the disc level which had to be fused.

What is the likelihood that a patient who had a fusion gets Adjacent Segment Disease?

Studies have suggested that the chance that a disc next to a fusion will require surgery to be about 3% per year after the fusion. By 10 years, 25% of these patients would need surgery at a disc next to a fusion.

How is Adjacent Segment Disease treated?

Most cases of Adjacent Segment Disease may not need treatment other than conservative, non-surgical spine care. However, patient with severe pain who have not responded to conservative care or those who have significant neurological problems can be treated with the following options:

  1. A discogram is often performed first to make sure the disc next to the fusion is in fact the source of the pain. Sometimes the pain comes from the fusion itself and not from a disc next to the fusion.
  2. The fusion can be extended to include the diseased disc next to the original fusion.
  3. Sometimes an Artificial Disc Replacement is an option next to a fusion to maintain some movement at that spinal level. This may be somewhat controversial as Artificial Disc Replacements were not specifically designed for this situation. However, some studies appear to indicate that this is a potential option.

What are some of the surgeries available for Adjacent Segment Disease?

  1. Anterior Cervical Discectomy and Fusion (ACDF)
  2. Cervical Artificial Disc Replacement (C-ADR)