58 - Adjacent Segment Degeneration and Disease of the Cervical Spine

Abstract

A major question in cervical spine surgery is whether adjacent segment pathology is a consequence of cervical fusion or whether it represents the natural history of cervical spondylosis. Adjacent segment pathology encompasses two terms: adjacent segment degeneration and adjacent segment disease. The former describes degenerative changes, whereas the latter describes clinically symptomatic degenerative changes. Cervical fusion has been shown to biomechanically alter adjacent segments, and clinically this has been associated with increased rates of both adjacent segment degeneration and disease. Recent research into cervical disc arthroplasty has shown both improved postoperative biomechanics and decreased incidence of adjacent segment pathology; however, the long-term results are still being researched. For either surgical option, soft tissue handling is vital to preventing adjacent segment pathology. Specifically, in anterior cervical discectomy and fusion, plate placement and cervical alignment must be considered to best preserve the adjacent segments.