Adjacent segment disease

1. Adjacent Segment disease
Dr. Tungish Bansal
Fellow Spine Surgery
Moderator: Dr. Sachin Borkar

2. Case
• 46 year old male.
• Difficulty in walking and Gait imbalance x 6-7
months
• No bowel bladder involvement.
Patient had similar complaints 3 years back and
was operated at a private hospital for the same
with C5-6 ,C6-7 ACDF.
Patient improved significantly and was doing
well until 7 months back.

3. Clinical examination
• Gait imbalance present
• Tone increased both lower limbs
• Power Rt /lt
• Shoulder 3/5 3/5
• Elbow 4/5. 4/5
• Wrist 3+/5. 3+/5
• HandGrip 50-60% 50%
• Hip &Knee 3/5 3/5
• Ankle 3/5. 3/5
• EHL 3/5 3/5

4. Clinical Examination Cont’d
• BJ 3+/3+
• SJ 3+ /3+
• TJ 3+/3+
• KJ 3+/3+
• AJ 3+/3+
• Hoffmans B/L positive
• Planter B/L upgoing
• Decreased sensation below C6 by 30-40 %.
• No perianal sensory loss.

5. AUG 2018 OCT 2021

6. Definition
• ASD refers to any abnormal process that
develops in the mobile segment next to a
operated spinal level.
• This may include disc degeneration, Listhesis,
instability, hypertrophic facet joint arthritis,
herniated nucleus pulpous, and stenosis.
• Adjacent segment disease can be
symptomatic or asymptomatic

7. Adjacent segment
Degeneration (ASDeg)
Adjacent segment disease
(ASDis)
• Radiographic change in the
intervertebral discs adjacent
to the surgically treated
spinal level
• Regardless of the presence of
symptoms
Represents symptomatic
adjacent
segment degeneration, causing
pain or numbness due to
post-operative spinal instability
or nerve compression at level
adjacent to previously operated
level.

8. Incidence
Procedure ASD( Asymptomatic) ASD(Symptomatic)
Lumbar fusion 5.9 %/ year 1.8-2.5 %/ year
Cervical fusion 3% /year 1-1.5 % /year
Cervical disc replacement 3%/year 0.5%/year
Lumbar discectomy NA 1.35%/year

9. Risk factor for ASD

10. Preventive strategies for ASD in lumbar
spine
• Avoiding laminectomy if possible-
preservation of posterior elements decreases
the risk of ASD.
• Avoiding over distraction of interbody space
during fusion surgery.
• Treating osteoporosis
• Use of motion preserving techniques, where
possible.

11. • 120 patients
• Compared facetectomy, hemilaminectomy, and
total laminectomy on L4-5 fusion.
• After asix year follow-up, patients with total
laminectomy developed a significantly larger
number of ASDeg and ASDis cases.

12. • Compared the incidence of ASDeg in 41
patients with L4-5 PLIF with minimum disc
distraction (12.2%) v/s significant distraction
distracted disc space (31.8%).
• Lower incidence of ASDeg in minimum
distraction group.

13. Conclusion: Motion-preservation procedures had an advantage on reducing the
prevalence of ASDeg, ASDis and the reoperation rate due to the adjacent segment
degeneration compared with the lumbar fusion and the clinical outcomes
of the two procedures are similar.

14. Strategies of prevention in Cervical
Spine
• Maintenance of cervical Lordosis.
• Motion preserving surgeries.
• Avoidance of incorrect needle placement in
adjacent levels.

16. Take home message
• ASDeg and ASDis are a common occurrence.
• No surgical procedure is immune to ASDed
and ASDis.
• Preventive strategies should be employed to
reduce its incidence and associated
complications.

17. THANKYOU