New Classification for Clinically Symptomatic Adjacent Segment Pathology in Cervical Disc Disease
Study DesignClinical adjacent segment pathology (CASP) is common after cervical disc surgery. A critical examination of 320 patients operated for cervical disc prolapse revealed that CASP can also occur in patients with congenital and degenerative fusion of cervical spine. This has not been studied...
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doaj-02932704388e419baad1c4c5ddc3da782020-11-25T01:32:45ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462015-12-019694295110.4184/asj.2015.9.6.942869New Classification for Clinically Symptomatic Adjacent Segment Pathology in Cervical Disc DiseaseSrinivasan Sreeramulu Uddanapalli0Department of Neurosurgery, MIOT Hospitals, Chennai, India.Study DesignClinical adjacent segment pathology (CASP) is common after cervical disc surgery. A critical examination of 320 patients operated for cervical disc prolapse revealed that CASP can also occur in patients with congenital and degenerative fusion of cervical spine. This has not been studied in depth and there is a need for a practically applicable classification of CASP.PurposeTo develop a new classification scheme of CASP.Overview of LiteratureA review of the literature did not reveal a practically applicable classification incorporating the occurrence of CASP in congenital and degenerative fusion cases.MethodsThis was a retrospective analysis of 320 patients operated (509 disc spaces) on for cervical disc prolapse. Cases (n=316) were followed-up for 3-11 years. Random sampling of 220 patients with postoperative magnetic resonance imaging (MRI) in 165 cases was analyzed.ResultsSix symptomatic CASP cases required resurgery (1.9%), eight cases involved MRI proven CASP with axial neck pain only and 13 patients were asymptomatic with radiological adjacent segment pathology (RASP). The frequency rate was 8.5% (27/316). Four cases of congenital or degenerative fusion of vertebra developed CASP requiring surgery. CASP is classified as primary or secondary follows. Primary A1 was congenital fusion of vertebra and primary A2 was degenerative fusion of the vertebra. Secondary, which was after cervical disc surgery, comprised B1 (RASP in asymptomatic patients), B2 (CASP in patients with axial neck pain), and B3 (CASP with myeloradiculopathy). B3 was subdivided into single-level CASP (B3a) and multiple-level CASP (B3b).ConclusionsSymptomatic CASP requiring resurgery is infrequent. CASP can occur in patients with congenital and degenerative fusion of the cervical spine. A new classification for CASP along with treatment strategy is proposed. Patients in Primary CASP and B3 CASP require resurgery while others require only observation.http://www.asianspinejournal.org/upload/pdf/asj-9-942.pdfClinical adjacent segment pathologyAdjacent segment degenerationAdjacent segment diseaseAnterior cervical discectomyCervical disc prolapse |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Srinivasan Sreeramulu Uddanapalli |
spellingShingle |
Srinivasan Sreeramulu Uddanapalli New Classification for Clinically Symptomatic Adjacent Segment Pathology in Cervical Disc Disease Asian Spine Journal Clinical adjacent segment pathology Adjacent segment degeneration Adjacent segment disease Anterior cervical discectomy Cervical disc prolapse |
author_facet |
Srinivasan Sreeramulu Uddanapalli |
author_sort |
Srinivasan Sreeramulu Uddanapalli |
title |
New Classification for Clinically Symptomatic Adjacent Segment Pathology in Cervical Disc Disease |
title_short |
New Classification for Clinically Symptomatic Adjacent Segment Pathology in Cervical Disc Disease |
title_full |
New Classification for Clinically Symptomatic Adjacent Segment Pathology in Cervical Disc Disease |
title_fullStr |
New Classification for Clinically Symptomatic Adjacent Segment Pathology in Cervical Disc Disease |
title_full_unstemmed |
New Classification for Clinically Symptomatic Adjacent Segment Pathology in Cervical Disc Disease |
title_sort |
new classification for clinically symptomatic adjacent segment pathology in cervical disc disease |
publisher |
Korean Spine Society |
series |
Asian Spine Journal |
issn |
1976-1902 1976-7846 |
publishDate |
2015-12-01 |
description |
Study DesignClinical adjacent segment pathology (CASP) is common after cervical disc surgery. A critical examination of 320 patients operated for cervical disc prolapse revealed that CASP can also occur in patients with congenital and degenerative fusion of cervical spine. This has not been studied in depth and there is a need for a practically applicable classification of CASP.PurposeTo develop a new classification scheme of CASP.Overview of LiteratureA review of the literature did not reveal a practically applicable classification incorporating the occurrence of CASP in congenital and degenerative fusion cases.MethodsThis was a retrospective analysis of 320 patients operated (509 disc spaces) on for cervical disc prolapse. Cases (n=316) were followed-up for 3-11 years. Random sampling of 220 patients with postoperative magnetic resonance imaging (MRI) in 165 cases was analyzed.ResultsSix symptomatic CASP cases required resurgery (1.9%), eight cases involved MRI proven CASP with axial neck pain only and 13 patients were asymptomatic with radiological adjacent segment pathology (RASP). The frequency rate was 8.5% (27/316). Four cases of congenital or degenerative fusion of vertebra developed CASP requiring surgery. CASP is classified as primary or secondary follows. Primary A1 was congenital fusion of vertebra and primary A2 was degenerative fusion of the vertebra. Secondary, which was after cervical disc surgery, comprised B1 (RASP in asymptomatic patients), B2 (CASP in patients with axial neck pain), and B3 (CASP with myeloradiculopathy). B3 was subdivided into single-level CASP (B3a) and multiple-level CASP (B3b).ConclusionsSymptomatic CASP requiring resurgery is infrequent. CASP can occur in patients with congenital and degenerative fusion of the cervical spine. A new classification for CASP along with treatment strategy is proposed. Patients in Primary CASP and B3 CASP require resurgery while others require only observation. |
topic |
Clinical adjacent segment pathology Adjacent segment degeneration Adjacent segment disease Anterior cervical discectomy Cervical disc prolapse |
url |
http://www.asianspinejournal.org/upload/pdf/asj-9-942.pdf |
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