title: Adjacent segment disease after instrumented fusion for idiopathic scoliosis: review of current trends and controversies.
abstract: METHODS
  A literature-based review.
  
  
  OBJECTIVE
  To summarize the clinical and morphologic findings leading to diagnosis, the etiologic factors, and principles of management. To identify the strengths and limits of past studies.
  
  
  BACKGROUND
  There are considerable controversies regarding etiologic factors, diagnosis, and management of adjacent segment disease in patients instrumented for idiopathic scoliosis.
  
  
  METHODS
  Summarized is past literature and, to some extent, personal experience of the authors.
  
  
  RESULTS
  Several factors participating to this complex pathophysiology are reported. The clinical presentation, occurring after symptom free interval, can vary, and modern morphologic investigations help for diagnosis. Management is often surgical and remains challenging.
  
  
  CONCLUSIONS
  Long-term consequences of spinal fusions are now major concerns, especially in young patients undergoing surgical correction for idiopathic scoliosis. Adjacent segment disease is defined by a combination of clinical symptoms and morphologic findings. Several etiologic factors have been reported, but need to be further studied to prevent and improve the surgical management of this complication.
authors.affiliation: Department of Orthopedics, Mayo Clinic/Mayo Foundation, Rochester, MN 55905, USA.
authors.forename: Brice
authors.initials: B
authors.lastname: Ilharreborde
authors.forename: Etienne
authors.initials: E
authors.lastname: Morel
authors.forename: Keyvan
authors.initials: K
authors.lastname: Mazda
authors.forename: Mark B
authors.initials: MB
authors.lastname: Dekutoski
mesh_terms: D000367:Age Factors; D006801:Humans; D007049:Iatrogenic Disease; D016268:Internal Fixators / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D012008:Recurrence; D012600:Scoliosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013904:Thoracic Vertebrae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013995:Time; D016896:Treatment Outcome