{"id":"3927843b-5158-4238-ac8b-d0289ec17d86","slug":"short-review-perspective-on-adjacent-segment-disease-asd-following-cervical-fusion-versus-arthroplasty","title":"Short Review/Perspective on Adjacent Segment Disease (ASD) Following Cervical Fusion Versus Arthroplasty","authors":["Nancy E. Epstein","Marc A. Agulnick"],"abstract":"Background: Although the incidence of radiographic Adjacent Segment Disease (ASD) following anterior cervical diskectomy/fusion (ACDF) or cervical disc arthroplasty (CDA) typically ranges from 2-4%/year, reportedly fewer patients are symptomatic, and even fewer require secondary surgery. Methods: Multiple studies have documented a 2-4% incidence of radiographic ASD following either ACDF or CDA per year. However, fewer are symptomatic from ASD, and even fewer require additional surgery/reoperations. Results: In a meta-analysis (2016) involving 83 papers, the incidence of radiographic ASD per year was 2.79%, but symptomatic disease was present in just 1.43% of patients with only 0.24% requiring secondary surgery. In another study (2019) involving 38,149 patients undergoing ACDF, 2.9% (1092 patients; 0.62% per year) had radiographic ASD within an average of 4.66 postoperative years; the younger the patient at the index surgery, the higher the reoperation rate (i.e. < 40 years of age 4.56 X reoperations vs. <70 at 2.1 X reoperations). In a meta-analysis of 32 articles focusing on ASD 12–24 months following CDA, adjacent segment degeneration (ASDeg) occurred in 5.15% of patients, but adjacent segment disease (AS Dis) was noted in just 0.2%/ year. Further, AS degeneration occurred in 7.4% of patients after 1-level vs. 15.6% following 2 level fusions, confirming that CDA’s “motion-sparing” design did not produce the “anticipated” beneficial results. Conclusion: The incidence of radiographic ASD ranges from 2-4% per year for ACDF and CDA. Additionally, both demonstrate lesser frequencies of symptomatic ASD, and the need for secondary surgery. Further, doubling the frequency of ASD following 2 vs. 1-level CDA, should prompt surgeons to limit surgery to only essential levels.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/3927843b-5158-4238-ac8b-d0289ec17d86/featured/hero-cropped-1781561148773.jpg","publishDate":"2022-07-22T00:00:00.000Z","doi":"10.25259/SNI_541_2022","categories":["Spine","Review Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2022/07/11737/SNI-13-313.pdf"}