Adjacent segment degeneration discussion. Pt underwent long | Figure 1

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Adjacent segment degeneration discussion. Pt underwent long segment discectomies & fusion C4-7 12 years ago. Pt had improved pain relief and less myelopathic findings although noted expected significant range of motion restrictions. Pt remained without worsening until recent motor vehicle accident. Pt developed unremitting shoulder pain. MRI showed C3-4 extruded disc with metallic artifact due to instrumentation. CT myelogram done to verify fusion & canal. Status failed to improve with conservative tx, decision for surgery made. Considerations: type of surgery given prior fusion, Pt will lose further mobility. Note when a Pt has undergone fusion there is added stress on the non fused or mobile segments..this can lead to adjacent segment degeneration. In other words, a long segment of fusion could place that Pt at risk for future disc disease.

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Spinal instrumentation has expanded in 2 decades. Here's an example of relatively new implants for cervical discectomy and fusion. This method avoids the use of the plate with an integrated screw system. It is still an instrumented fusion albeit lower profile anteriorly. Another area of growth is the artificial disc replacement to supposedly preserve motion. A fusion essentially stops movement at that segment. An artificial disc presumably allows motion and therefore may help to alleviate future stress on the adjacent segments.

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