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Adjacent segment disease of the cervical spine: fact or fiction

Ponnappan, Ravi K; Hilibrand, Alan S

doi: 10.1097/BCO.0b013e3282fc9ab2
SPECIAL FOCUS: Cervical Spine

Purpose of review Recent innovation and controversy in spine surgery has centered on the incidence, treatment and prevention of adjacent segment degeneration. This review will focus on the recent published literature pertaining to adjacent segment degeneration and disease of the cervical spine from 2006–2007 and highlight the current controversy, advancements and failures of treatment options.

Recent findings Recent publications continue to show increased rates of adjacent segment degenerative changes at long-term follow-up, with a constant rate of symptomatic disease. Biomechanical analyses indicate that increased stress may be a factor in precipitating accelerated degeneration, however, a clinical evaluation of post patients after surgery shows more global distribution of adjacent segment motion. Technique-related factors also may play a role in adjacent segment degeneration, that is kyphotic alignment and plate position. Short-term clinical results from total disk replacement have shown clinical equivalence to anterior decompression and fusion; however, reoperation for adjacent segment disease continues to be reported.

Summary Adjacent segment disease continues to be a concern as more long-term clinical outcome data of anterior fusions emerge. The etiology of the problem continues to be elusive and is likely multifactorial. The effect of motion-sparing technology will be further revealed as long-term outcomes data become available.

Thomas Jefferson University, Philadelphia, USA

Correspondence to Ravi K. Ponnappan, MD, 925 Chestnut St., Rothman Institute, Philadelphia, PA 19107, USA Tel: +1 609 677 6060; fax: +1 609 677 6061; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.