University of Wisconsin Midwest Orthopaedics at Rush University University of Kansas University of Utah Spectrum Research, Inc. University of Washington University of California, San Francisco The Mayo Clinic Dwight D. Eisenhower Army Medical Center University of Toronto University of Saskatchewan, Royal University Hospital Thomas Jefferson University, Rothman Institute University of Virginia Washington University Indiana Spine Group University of Washington University of California, Los Angeles.
Spine (Impact Factor: 2.3). 08/2012; 37(22 Suppl). DOI: 10.1097/BRS.0b013e31826d62ed
Source: PubMed
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Available from: John G Devine, Nov 15, 2014
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    ABSTRACT: Anterior cervical discectomy and fusion (ACDF) is widely accepted as a predictably excellent procedure. On the other hand, adjacent level pathology following ACDF is a well-known phenomenon which undercuts surgical outcome. However, the extent to which ACDF accelerates this phenomenon in the naturally degenerating cervical spine is still to be understood. To summarize the current evidence concerning adjacent segment pathology in the light of biomechanics, natural history, postoperative course, and comparison between ACDF and total disc replacement (TDR). This is a study of published articles. Articles were searched by the topic of adjacent disc pathology in cervical spine through Google Scholar and Pubmed. After review, 37 published articles were deemed suitable for the subject of this study. Biomechanical and clinical data strongly suggest that ASP is a presentation of the iatrogenically accelerated natural aging process of cervical spine. However, power study analysis with assumption showed that current RCTs are unlikely to prove this suggestion. Available data suggests that iatrogenic factors play a significant role in adjacent segment pathology following ACDF.
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    ABSTRACT: Study Design. A retrospective comparative studyObjective. To investigate adjacent segment pathology (ASP) after limited lumbar fusion in the treatment of degenerative lumbar scoliosis (DLS).Summary of Background Data. The assessment of appropriate surgical techniques for DLS remains one of the most controversial topics in spinal surgery. So far, there has been no study specifically addressing why ASP shows different patterns with respect to different fusion levels after instrumented lumbar fusion for DLS.Methods. 59 patients were enrolled and divided into two groups with respect to the proximal fusion level: Group I consisted of 29 patients who underwent fusion below the proximal neutral vertebrae, and Group II consisted of 30 patients who underwent fusion to the proximal neutral vertebrae. Clinical and radiological assessments were performed with an average of 59.4 months of follow-up. The number of radiological findings for ASP was determined based on a 7-point scale that gave 1 point for each radiological finding. The two groups were analyzed according to radiological ASP (RASP). The ODI and VAS were recorded prospectively.Results. Overall, RASP developed in 16 (27.1%) patients. In Group I, 12 (41.4%) out of 29 patients, and in Group II, 4 (13.3%) out of 30 patients showed RASP. Group I yielded an average of 4.5 points, and in Group II, 1.8 points. RASP scores were much higher in Group I than in Group II, with statistical significance (p = 0.000). In Group I, 4 patients underwent revision surgery, but in Group II, only 1 patient did so.Conclusion. RASP displayed variance according to different fusion levels. RASP in Group I showed similar patterns to the natural progression of DLS. It is suggested that fusion be included at least at the proximal neutral vertebrae to reduce RASP although RASP with different patterns is unavoidable.
    No preview · Article · Apr 2014 · Spine
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    ABSTRACT: Study Design Retrospective cohort study. Objective To identify the incidence of adjacent segment pathology (ASP) after thoracolumbar fusion of three or more levels, the risk factors for the development of ASP, and the need for further surgical intervention in this particular patient population. Methods A retrospective analysis of a prospective surgical database identified 217 patients receiving polysegmental (≥ 3 levels) spinal fusion with minimum 5-year follow-up. Risk factors were evaluated, and the following data were obtained from the review of radiographs and charts: radiographic measures—levels fused, fusion status, presence of ASP; clinical measures—patient assessment, Oswestry Disability Index (ODI), and the need for further surgery. Results The incidence of radiographic ASP (RASP) was 29%; clinical or symptomatic ASP (CASP), 18%; and those requiring surgery, 9%. Correlation was observed between ODI and ASP, symptomatic ASP, and need for revision surgery. Age, preoperative degenerative diagnosis, and absence of fusion demonstrated significant association to ASP. Conclusions ASP was observed in a significant number of patients receiving polysegmental fusion of three or more levels. ODI scores correlated to RASP, CASP, and the need for revision surgery.
    Preview · Article · Jun 2014 · Global Spine Journal
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