Adjacent segment disease: fact or fiction?

Abstract

In medico-legal practice we see a lot of people with vertebral injuries and disc/soft-tissue injuries. There are frequently discussions on the cause of the claimant’s pain and whether it is related to a specific injury or incident or whether it is part and parcel of their constitutional condition. It is well accepted by surgeons who regularly see and assess patients with back pain in their clinical practice that the vast majority of patients with low back pain do not have a specific cause for that pain and we label them as having non-specific low back pain (NSLBP). However, during the process of litigation we are sometimes challenged to give an opinion on the prognosis of claimants who have undergone spinal fusion surgery. There are three groups of claimants that we might see during the process of litigation who have undergone spinal fusion:- 1. Those who have had an injury where they have sustained a spinal fracture which has been operated on with pedicle screw/rod fixation. 2. Those who may have suffered a disc injury/prolapse secondary to a particular injury or trauma that is the subject of litigation (a controversial subject in itself) and as part of their treatment have undergone discectomy and fusion. 3. Those who have had previous spinal fusion surgery for constitutional reasons and who now have an injury that is the subject of litigation. In these people there is often discussion among spinal experts about the question of adjacent segment disease and whether the long-term prognosis for the claimant …