ADJACENT SYNDROME IN SPINE SURGERY

Have you ever heard that you should not get a spine surgery, because otherwise you are just gonna require more and more spine surgery?

Well, let's try to understand what is behind that idea.

What is adjacent syndrome in spine surgery?

This is the deterioration of a joint - usually the disc: adjacent disc disease - above or below a segment of the spine that has been fused.

This can lead to a new onset of pain (lower back pain, cruralgia or sciatica) several years after the initial surgery.

Why it happens?

• Mostly because of a previous spine fusion: This involves healing two or more vertebrae together, thus eliminating mobility between them. Since mechanical stress is no longer absorbed by the joint between the fused vertebrae, the stresse are distributed above and below the fused segment. This is therefore a compensation phenomenon.

How to avoid an adjacent syndrome?

• Artificial disc replacement: Artificial discs offer an alternative solution to fusion. With an artificial disc the mobility between two vertebrea is restored. Thus there is no excessive stress on the adjacent segments. Disc adjacent to a lumbar disc replacement are less likely to degenerate over time.

  
  

• In case of spine fusion:

  • Fusion must be performed in a "good position." The position in which the vertebrae are immobilized has a direct impact on the shearing forces applied on the adjacent levels. Mostyl in lumbar spine, the correct amount of lordosis has to be restored in the fused area. The amount of lordosis is determined based on the level operated on, and the anatomy of each patient. Surgical planning is therefore essential. It is a matter of analyzing and respecting the sagittal balance of the spine as much as possible.

  • The discs adjacent to the arthrodesis must be in relatively good condition.

What is the treatment?

The treatment is primarily medical: physiotherapy, painkillers, possibly injections.

If a properly conducted medical treatment fails, surgical treatment may be necessary.

Surgery will consist of treating the overlying level, striving to find a solution that would minimize the risks of new adjacent syndrome based on the principles stated previously. Severals surgical options are to be discussed based on the symptoms and on the radiologic analysis: artificial disc replacement, new fusion, or minimally invasive nerve release.

In some complex situations, it is sometimes necessary to modify the area that has already been operated on so that the phenomenon does not happen again.