Adjacent Segment Disease (ASD) in Incidental Segmental Fused Vertebra and Comparison With the Effect of Stabilization Systems on ASD

Abstract

Adjacent segment disease is a controversial process after spine stabilization. The two important factors discussed are natural aging and hypermobility in incidental segmental fusion anomalies; patients have two or more fused vertebrae from birth, which are the results of spinal movement restriction due to the fusion of some spinal units. This article's main purpose is to determine the degree of relationship of hypermobility and the aging process in the deterioration of the disks adjacent to fusion. MethodsIn this study, the degenerative process developed by hypermobility in the adjacent segment due to incidental segmental fusion was evaluated. The MRI images of 52 adjacent and nonadjacent disks of 45 patients in total were analyzed according to the Pfirrmann grading systems. The average Pfirrmann rating of the disks just above and below the fused segment and the distant first, second, and third non-neighboring levels were evaluated and calculated, respectively. ResultsThe highest rate of incidental fusion is determined on the cervical area with 51.9%, followed by the thoracal area with 32.7%, and the lumbar area with 15.4%. Damage to the adjacent segment disks in cases with incidental fusion can still be seen at any age, with fusion, indicating that the hypermobility effect plays a more prominent role. The evidence of hypermobility without aging is that the segments adjacent to fusion undergo more degeneration than the distant disks. ConclusionAdjacent segment disease is under the influence of many factors. Our findings suggest that its incidence is increasing with the pathological processes initiated by hypermobility. It seems that, at least, it carries equal importance as compared to age. Fusion surgeries damage the adjacent segments under the influence of the passage of time beyond the physiological aging of the patient.

Biomechanical comparison of spinal column shortening - a finite element study

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Application of dual-trajectory screws in revision surgery for lumbar adjacent segment disease: a finite element study

“…However, advances in medical technology in recent years have helped promote the use of cortical bone trajectory (CBT) screws, which, compared with TT screws, cause only mild denudation of the soft tissue and less nerve and vascular damage and have a greater anti-pullout force [2]. However, due to the intraoperative resection of the lamina and intervertebral disc, injury of the facet joint and fusion of long segments, the range of motion (ROM) and stress of adjacent segments are increased, thus accelerating the degeneration of adjacent segments [3][4][5]. As a result, a series of resulting clinical symptoms affects the patients' quality of life.…”

A comparative analysis of using cage acrossing the vertebral ring apophysis in normal and osteoporotic models under endplate injury: a finite element analysis

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