Science In Brief

Chiropractic Litterature Review


The Study: Adjacent Segment Pathology after Anterior Cervical Fusion.

The Facts:

  1. A complication of anterior cervical fusion is the "development of clinically significant disc disease at levels adjacent to fused discs".
  2. As patients are having these surgeries and are also living longer, it may be that as greater amounts of time pass following these surgeries we will see more of these types of problems.
  3. The reasons for why adjacent segment pathology develops following surgery are not well understood. Factors such as smoking, age, activities and gender among other factors may play a role.
  4. In addition such factors as biomechanical stresses and "postoperative sagittal alignment" may be factors.
  5. Among the many things that are recommended for surgeons to do to help reduce the occurrence of this condition is "preservation of lordosis".

Take Home:

Patients can develop problems in the discs adjacent to the discs that have been surgically fused.

Reviewer's Comments:

One reason I reported on this article is that once again we see spinal misalignment playing a role in producing problems. Surgeons are becoming more concerned with the effects of post surgical posture on their outcomes. Another interesting article on this subject which you might also want to review is by our friend Stephan J. Troyanovich, DC titled Does anterior plating maintain cervical lordosis versus conventional fusion techniques? A retrospective analysis of patients receiving single-level fusions. J Spinal Disord Tech. 2002 Feb;15(1):69-74.

Reviewer: Roger Coleman DC

Editor's Comments: This study specifically cites the effects of "increased mobility, increased loading or increased intradiscal pressure that ultimately accelerate disc degeneration." The authors even state that "increased mechanical demands adversely affect the disc by interfering with its normal nutritional supply" all of which is basic Chiro 101. And while these facts are no doubt obvious to all DCs, it's worth noticing that this article, which concentrates much of its discussion on the relationship between structure (lordosis) and function, is once again being written by surgeons, not chiropractors. I couldn't help but notice that at no point did the authors mention that the very lordosis which is so important to maintain for good post surgical outcomes, might well have prevented the need for surgery in the first place had the patient received early postural intervention.

Editor: Mark R. Payne DC

Reference:Chung JY, Park JB, Seo HY, Kim SK. Adjacent Segment Pathology after Anterior Cervical Fusion. Asian Spine J. 2016 Jun;10(3):582-92. doi: 10.4184/asj.2016.10.3.582. Epub 2016 Jun 16.

Link to Abstract:



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