title: Adjacent Segment Pathology: Progressive Disease Course or a Product of Iatrogenic Fusion?
abstract: OBJECTIVE
  Cervical spine clinical adjacent segment pathology (CASP) has a reported 3% annual incidence and 26% ten-year prevalence. Its pathophysiology remains controversial, whether due to mechanical stress of a fusion segment on adjacent levels or due to patient propensity to develop progressive degenerative change. We investigate this relationship by comparing prevalence of CASP in traumatic and spondylotic patient cohorts.
  
  
  METHODS
  A retrospective review of traumatic cervical spine fusion cases performed by the local group of neurosurgeons from 2004-2008 was completed. Surgery for CASP and presence of radiological adjacent segment pathology (RASP) were identified by telephone and electronic medical record (EMR) review, and compared to those in patients having elective cervical fusion for degenerative disease.
  
  
  RESULTS
  There was a higher proportion of males (50/100 vs. 37/46, p0.05). Mean follow-up times were different (6.4 years in the trauma group, 7.1 years in the degenerative group; p<0.01), although this was not thought to be clinically significant. The degenerative group was found to have a significantly higher reoperation rate for CASP (10/100 vs. 0/46, p=0.031, Fisher's Exact Test), and rate of RASP (20/100 vs. 1/32, p=0.025) Conclusion: This is the only cohort study to our knowledge comparing surgery for CASP in trauma patients to those with degenerative disease. A higher rate of repeat surgery in degenerative disease patients was found. This suggests that CASP is more related to patient factors predisposing to progressive degenerative disease and not increased mechanical stress.
authors.affiliation: Division of Neurosurgery,Department of Surgery,University of Alberta Hospital,Edmonton,Alberta,Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Jack
authors.affiliation: Division of Neurosurgery,Department of Surgery,University of Alberta Hospital,Edmonton,Alberta,Canada.
authors.forename: Godefroy
authors.initials: G
authors.lastname: Hardy St-Pierre
authors.affiliation: Division of Neurosurgery,Department of Surgery,University of Alberta Hospital,Edmonton,Alberta,Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Nataraj
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D013122:Spinal Diseases / Q000473:pathology* / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects*; D013689:Telephone; D016896:Treatment Outcome
keywords: Adjacent segment disease; adjacent segment degeneration; adjacent segment pathology; anterior cervical discectomy and fusion; cervical fusion; clinical adjacent segment pathology