Accelerated adjacent segment degeneration, or adjacent segment disease, attributes the fusing of one or two levels in the spine to increased stress at the remaining adjacent levels of the spine. The adjacent levels then tend to degenerate at an accelerated rate because of the increased load and stress.
For cervical discogenic conditions such as herniated discs and bulging or ruptured discs, the accepted treatment for years has been the anterior cervical discectomy and fusion surgery, or ACDF. Although effective in a short term positive outcome, the surgery has become very closely tied to an adverse long term condition, adjacent segment disease. Studies have followed patients who have undergone the anterior cervical discectomy and fusion surgeries and found that a significantly high percentage of patients demonstrate degeneration in the levels adjacent (beneath and above) the fused vertebrae. These patients usually require additional cervical fusion surgeries; a domino effect on the spine.
The Cause of Adjacent Segment Disease
The cause of the increased risk for adjacent degeneration has been linked to the biomechanical stress of the fusion on the surrounding vertebrae after the fused vertebrae are deemed motionless. As many as 1 in 5 patients who have undergone a cervical fusion will require additional fusion surgeries on degenerated discs adjacent to their fusion.
The preservation of motion for the affected level in the initial treatment plan will prevent this increased stress to the spine and prevent accelerated degeneration in the levels surrounding the herniation or disc of concern. The best treatment option available that provides this preservation of motion for the disc is Deuk Laser Disc Repair as an alternative to cervical fusion surgery.
Deuk Laser Disc Repair uses an endoscope and a laser to remove the herniated disc material from the vertebral column and the pathways housing the delicate nerves and spinal cord. The disc is then able to heal itself and perform naturally as a buffer and shock absorber retaining a normal range of motion for the patient and reducing the risk of adjacent degeneration of the spine.
Case Study of Adjacent Segment Disease
A patient with a 2-year-old anterior cervical discectomy and fusion at the c5-c6 level presents with pain in the neck, or cervical spine, increased with movement. MRI findings indicate clinically significant disc disease in the levels adjacent to the cervical fusion at C4-C5 and C6-C7. The patient is recommended for two additional cervical fusion surgeries on the adjacent levels showing diseased state resulting in loss of motion in three levels of the spine and the risk for even greater accelerated degeneration on the remaining spinal discs.