Iatrogenic contributions to cervical adjacent segment pathology: review article.
BACKGROUND
Anterior cervical discectomy and fusion (ACDF) is widely accepted as a predictably excellent procedure. On the other hand, adjacent level pathology following ACDF is a well-known phenomenon which undercuts surgical outcome. However, the extent to which ACDF accelerates this phenomenon in the naturally degenerating cervical spine is still to be understood.


OBJECTIVE
To summarize the current evidence concerning adjacent segment pathology in the light of biomechanics, natural history, postoperative course, and comparison between ACDF and total disc replacement (TDR).


METHODS
This is a study of published articles. Articles were searched by the topic of adjacent disc pathology in cervical spine through Google Scholar and Pubmed. After review, 37 published articles were deemed suitable for the subject of this study.


RESULTS
Biomechanical and clinical data strongly suggest that ASP is a presentation of the iatrogenically accelerated natural aging process of cervical spine. However, power study analysis with assumption showed that current RCTs are unlikely to prove this suggestion.


CONCLUSIONS
Available data suggests that iatrogenic factors play a significant role in adjacent segment pathology following ACDF.
Hospital for Special Surgery Spine Care Institute, Weill Cornell College of Medicine, New York, NY 10065 USA ; Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Haruki
H
Ueda
Hospital for Special Surgery Spine Care Institute, Weill Cornell College of Medicine, New York, NY 10065 USA.
Russel C
RC
Huang
Hospital for Special Surgery Spine Care Institute, Weill Cornell College of Medicine, New York, NY 10065 USA.
Darren R
DR
Lebl
adjacent segment pathology; anterior cervical discectomy and fusion; prognosis; reoperation; total disc arthroplasty