Iatrogenic Contributions to Cervical Adjacent Segment Pathology

HSS Journal Volume 11, Number 1 February, 2015

Haruki Ueda, MD

HSS Spine, Hospital for Special Surgery

Russel C. Huang, MD
Russel C. Huang, MD
Director of Spine Surgery Clinic, Hospital for Special Surgery
Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College
Associate Attending Orthopaedic Surgeon, New York - Presbyterian Hospital
Darren R. Lebl, MD, FAAOS
Darren R. Lebl, MD, FAAOS
Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery
Assistant Scientist, Research Division, Hospital for Special Surgery
Assistant Professor of Orthopaedic Surgery, Weill Medical College of Cornell University



Anterior cervical discectomy and fusion (ACDF) is widely accepted as a predictably excellent procedure. On the other hand, adjacent level pathology following ACDF is a well-known phenomenon which undercuts surgical outcome. However, the extent to which ACDF accelerates this phenomenon in the naturally degenerating cervical spine is still to be understood.


To summarize the current evidence concerning adjacent segment pathology in the light of biomechanics, natural history, postoperative course, and comparison between ACDF and total disc replacement (TDR).


This is a study of published articles. Articles were searched by the topic of adjacent disc pathology in cervical spine through Google Scholar and Pubmed. After review, 37 published articles were deemed suitable for the subject of this study.


Biomechanical and clinical data strongly suggest that ASP is a presentation of the iatrogenically accelerated natural aging process of cervical spine. However, power study analysis with assumption showed that current RCTs are unlikely to prove this suggestion.


Available data suggests that iatrogenic factors play a significant role in adjacent segment pathology following ACDF.

This article appears in the HSS Journal: Volume 11, Issue 1.
View the full HSS Journal at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


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