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Terminology

Anderson, Paul A., MD; Andersson, Gunnar B. J., MD, PhD; Arnold, Paul M., MD, FACS; Brodke, Darrel S., MD; Brodt, Erika D., BS; Chapman, Jens R., MD; Chou, Dean, MD; Dekutoski, Mark, MD; Dettori, Joseph R., MPH, PhD; DeVine, John G., MD; Ely, Claire G., BS; Fehlings, Michael G., MD, PhD, FRCSC; Fischer, Dena J., DDS, MSD, MS; Fourney, Daryl R., MD, FRCSC, FACS; Hansen, Mitchell A., BS, MBBS, Grad Dip Sc, PhD, FRACS; Harrod, Christopher Chambliss, MD; Hashimoto, Robin, PhD; Hermsmeyer, Jeffrey T., BS; Hilibrand, Alan S., MD; Kasliwal, Manish K., MD, MCh; Kelly, Michael P., MD; Kim, Han Jo, MD; Kraemer, Paul, MD; Lawrence, Brandon D., MD; Lee, Michael J., MD; Lenke, Lawrence G., MD; Norvell, Daniel C., PhD; Raich, Annie, MPH; Riew, K. Daniel, MD; Shaffrey, Christopher I., MD, FACS; Skelly, Andrea C., MPH, PhD; Smith, Justin S., MD, PhD; Standaert, Christopher J., MD; Van Alstyne, Ellen M., MS; Wang, Jeffrey C., MD

doi: 10.1097/BRS.0b013e31826d62ed
Introduction
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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

Spectrum Research, Inc.

Dwight D. Eisenhower Army Medical Center

Spectrum Research, Inc.

University of Toronto

Spectrum Research, Inc.

University of Saskatchewan, Royal University Hospital

University of Toronto

Thomas Jefferson University, Rothman Institute

Spectrum Research, Inc.

Spectrum Research, Inc.

Thomas Jefferson University, Rothman Institute

University of Virginia

Washington University

Washington University

Indiana Spine Group

University of Utah

University of Washington

Washington University

Spectrum Research, Inc.

Spectrum Research, Inc.

Washington University

University of Virginia

Spectrum Research, Inc.

University of Virginia

University of Washington

Spectrum Research, Inc.

University of California, Los Angeles

Address correspondence and reprint requests to K. Daniel Riew, MD, Department of Orthopaedic Surgery, Washington University, One Barnes Jewish Hospital Plaza, Suite 11300, West Pavilion, St. Louis, MO 63110; E-mail: riewd@wustl.edu

Acknowledgment date: July 10, 2012. Acceptance date: July 31, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Supported by AOSpine North America, Inc. Analytic support for this work was provided by Spectrum Research, Inc., with funding from the AOSpine North America.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision making position.

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Terminology—Adjacent Segment Pathology

We the undersigned propose “Adjacent Segment Pathology” as the general term to describe changes that occur adjacent to a previously operated level. Under this heading, “Radiographic Adjacent Segment Pathology” (RASP) refers to radiological changes that occur at the adjacent segment. “Clinical Adjacent Segment Pathology” (CASP) refers to clinical symptoms and signs that occur at the adjacent segment.

The purpose of this new nomenclature is to:

  1. Standardize terminology for clinicians so that they are speaking the same regarding definitions.
  2. Set the stage for more meaningful and logical classification of disease.
  3. Assist in separating out conditions that may require intervention from those that may not require intervention.
  4. Provide a more logical description of the primary considerations—radiographical, which may/may not correlate with symptoms and need additional intervention versus clinical, which clarifies that patient symptomatology is present.
  5. Simplify future literature searches and research on the topic. We can best accomplish this by eliminating the plethora of terms that have been utilized to describe the various pathologies that occur at the adjacent level.
Figure

Figure

Paul A. Anderson, MD

University of Wisconsin

Gunnar B. J. Andersson, MD, PhD

Midwest Orthopaedics at Rush University

Paul M. Arnold, MD, FACS

University of Kansas

Darrel S. Brodke, MD

University of Utah

Erika D. Brodt, BS

Spectrum Research, Inc.

Jens R. Chapman, MD

University of Washington

Dean Chou, MD

University of California, San Francisco

Mark Dekutoski, MD

The Mayo Clinic

Joseph R. Dettori, MPH, PhD

Spectrum Research, Inc.

John G. DeVine, MD

Dwight D. Eisenhower Army Medical Center

Claire G. Ely, BS

Spectrum Research, Inc.

Michael G. Fehlings, MD, PhD, FRCSC

University of Toronto

Dena J. Fischer, DDS, MSD, MS

Spectrum Research, Inc.

Daryl R. Fourney, MD, FRCSC, FACS

University of Saskatchewan, Royal University Hospital

Mitchell A. Hansen, BS, MBBS, Grad Dip Sc, PhD, FRACS

University of Toronto

Christopher Chambliss Harrod, MD

Thomas Jefferson University, Rothman Institute

Robin Hashimoto, PhD

Spectrum Research, Inc.

Jeffrey T. Hermsmeyer, BS

Spectrum Research, Inc.

Alan S. Hilibrand, MD

Thomas Jefferson University, Rothman Institute

Manish K. Kasliwal, MD, MCh

University of Virginia

Michael P. Kelly, MD

Washington University

Han Jo Kim, MD

Washington University

Paul Kraemer, MD

Indiana Spine Group

Brandon D. Lawrence, MD

University of Utah

Michael J. Lee, MD

University of Washington

Lawrence G. Lenke, MD

Washington University

Daniel C. Norvell, PhD

Spectrum Research, Inc.

Annie Raich, MPH

Spectrum Research, Inc.

K. Daniel Riew, MD

Washington University

Christopher I. Shaffrey, MD, FACS

University of Virginia

Andrea C. Skelly, MPH, PhD

Spectrum Research, Inc.

Justin S. Smith, MD, PhD

University of Virginia

Christopher J. Standaert, MD

University of Washington

Ellen M. Van Alstyne, MS

Spectrum Research, Inc.

Jeffrey C. Wang, MD

University of California, Los Angeles

© 2012 Lippincott Williams & Wilkins, Inc.