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Surgical Strategies to Prevent Adjacent Segment Disease in the Cervical Spine

Butler, Joseph S., PhD, FRCS; Morrissey, Patrick B., MD; Wagner, Scott C., MD; Kaye, I. David, MD; Sebastian, Arjun S., MD; Schroeder, Gregory D., MD; Vaccaro, Alexander R., MD, PhD, MBA; Hilibrand, Alan S., MD

doi: 10.1097/BSD.0000000000000632

The most popular approach to treating symptomatic cervical disk disease is anterior cervical discectomy and fusion. Although this procedure has significant long-term clinical success, it is associated with progressive adjacent segment degeneration with an annual incidence of ∼3%. Total disk arthroplasty was designed as an alternative to fusion that could preserve segmental motion at the operative level and potentially delay or prevent adjacent-level breakdown. The etiology of adjacent segment pathology (ASP) is multifactorial, and it is likely that most cases of ASP are unavoidable. When attempting to surgically prevent ASP, it is important to consider nonfusion alternatives, be judicious in one’s level selection, and attempt to restore sagittal alignment. When ASP becomes a clinical problem, it is important to have an algorithm for how best to treat it.

Rothman Institute, Thomas Jefferson University, Philadelphia, PA

Dr Schroeder has received funds to travel from AO Spine and Medtronic. Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, GersonLehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, BonovoOrthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. He has also served as deputy editor/editor of Spine. In addition, Dr Vaccaro has also provided expert testimony. The remaining authors declare no conflict of interest.

Reprints: Joseph S. Butler, PhD, FRCS, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107 (e-mail:

Received May 9, 2017

Accepted February 21, 2018

© 2019 by Lippincott Williams & Wilkins, Inc.