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Kyle M. Fargen, Richard C. E. Anderson, David H. Harter, Peter D. Angevine, Valerie C. Coon, Douglas L. Brockmeyer and David W. Pincus

continued growth of the anterior elements. 12 , 14 Other studies have not found any kyphotic, lordotic, or adjacent-segment pathology following occipitocervical fusion in children. 2 However, the effects of growth seen after occipitocervical fusion may not be easily translated to a rigid fixed segment from the occiput to the thoracic spine. It is widely accepted that OCT fusion results in near-total absence of cervical motion; however, this consensus has not been confirmed by biomechanical studies. Although no negative sequelae on neck growth were seen during the follow

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Reginald J. Davis, Kee D. Kim, Michael S. Hisey, Gregory A. Hoffman, Hyun W. Bae, Steven E. Gaede, Ralph F. Rashbaum, Pierce Dalton Nunley, Daniel L. Peterson and John K. Stokes

Kulkarni V , Rajshekhar V , Raghuram L : Accelerated spondylotic changes adjacent to the fused segment following central cervical corpectomy: magnetic resonance imaging study evidence . J Neurosurg 100 : 1 Suppl Spine 2 – 6 , 2004 31 Lawrence BD , Hilibrand AS , Brodt ED , Dettori JR , Brodke DS : Predicting the risk of adjacent segment pathology in the cervical spine: a systematic review . Spine (Phila Pa 1976) 37 : 22 Suppl S52 – S64 , 2012 32 Lopez-Espina CGAF , Amirouche F , Havalad V : Multilevel cervical fusion and its

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Colin P. McDonald, Victor Chang, Michael McDonald, Nicole Ramo, Michael J. Bey and Stephen Bartol

undergoing ACDF and AD replacement found in our study suggest that more attention should nonetheless be paid to the cervical facet joints when considering surgical treatment. Despite the aforementioned differences in cervical kinematics observed between our ACDF and AD groups, the fact remains that recently published long-term studies of cervical AD results show fairly equivocal results in developing adjacent-segment pathology. 7 , 8 , 16 This has led some authors to conclude that any degeneration at segments adjacent to a fusion is simply part of the natural history of

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Mohamad Bydon, Risheng Xu, David Santiago-Dieppa, Mohamed Macki, Daniel M. Sciubba, Jean-Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan and Timothy F. Witham

26 Kuslich SD , Ulstrom CL , Griffith SL , Ahern JW , Dowdle JD : The Bagby and Kuslich method of lumbar interbody fusion. History, techniques, and 2-year follow-up results of a United States prospective, multicenter trial . Spine (Phila Pa 1976) 23 : 1267 – 1279 , 1998 27 Lawrence BD , Wang J , Arnold PM , Hermsmeyer J , Norvell DC , Brodke DS : Predicting the risk of adjacent segment pathology after lumbar fusion: a systematic review . Spine (Phila Pa 1976) 37 : 22 Suppl S123 – S132 , 2012 28 Lee CK : Accelerated

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Sheeraz Qureshi, Vadim Goz, Steven McAnany, Samuel K. Cho, Andrew C. Hecht, Rick B. Delamarter and Michael G. Fehlings

This is the most common reason for revision at the index level: the risk of pseudarthrosis is obviated by CDR. Most studies comparing radiographic adjacent-level pathology in ACDF and CDR failed to find a difference between the two groups. 6 , 17 , 25 , 27 , 32 One randomized controlled trial did find a lower rate of radiographic adjacent-level pathology in the CDR group. 9 Long-term studies are necessary to further elucidate whether motion-sparing surgery decreases the rate of clinical adjacent-segment pathology. As more data become available on long

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Stephen M. Pirris and Sherri M. Kimes

T he potential for adjacent-segment breakdown following instrumented spine fusion due to the increased stress and motion above and below the fused and immobile segment is well established. 1 , 3 , 6 , 8 , 10 , 11 Adjacent-segment pathology is a broad term referring to clinical or radiological changes resulting from adjacent motion segments that occur following spinal surgery. 10 Adjacent-segment pathology is an increased finding in patients with longer instrumented fusion constructs. 8 Pseudarthrosis and hardware failure are two other common

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Kang Lu, Po-Chou Liliang, Hao-Kuang Wang, Cheng-Loong Liang, Jui-Sheng Chen, Tai-Been Chen, Kuo-Wei Wang and Han-Jung Chen

lumbar fusion with pedicle fixation . Spine (Phila Pa 1976) 29 : 2527 – 2532 , 2004 10.1097/01.brs.0000144408.02918.20 15543067 13 Lawrence BD , Wang J , Arnold PM , Hermsmeyer J , Norvell DC , Brodke DS : Predicting the risk of adjacent segment pathology after lumbar fusion: a systematic review . Spine (Phila Pa 1976) 37 : 22 Suppl S123 – S132 , 2012 14 Lee CH , Hyun SJ , Kim KJ , Jahng TA , Yoon SH , Kim HJ : The efficacy of lumbar hybrid stabilization using the DIAM to delay adjacent segment degeneration: an intervention

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Andrew T. Healy, Prasath Mageswaran, Daniel Lubelski, Benjamin P. Rosenbaum, Virgilio Matheus, Edward C. Benzel and Thomas E. Mroz

, in our study, more reliably indicate postoperative stability. It is possible that facet changes can predict segmental stabilization clinically, and future studies of adjacent-segment pathology or segmental instability should report disc and facet scores to better elucidate the role of CT-based image scoring and its relationship to segmental stability. With the ability to identify the stability of a segment, one could apply such grading to preoperative planning strategies. Limitations In our investigation, we used specimen data from previous studies in which

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Dominic Maggio, Tamir T. Ailon, Justin S. Smith, Christopher I. Shaffrey, Virginie Lafage, Frank Schwab, Regis W. Haid Jr., Themistocles Protopsaltis, Eric Klineberg, Justin K. Scheer, Shay Bess, Paul M. Arnold, Jens Chapman, Michael G. Fehlings, Christopher Ames, AOSpine North America and International Spine Study Group

(HRQOL) scores. 29 Based on normative spinopelvic parameter data, corrective surgery should target a sagittal vertical axis (SVA) < 50 mm and a PT < 20°. Furthermore, good postoperative HRQOL scores are correlated with a lumbar lordosis that is within approximately 10° of the pelvic incidence. 43 Postoperative positive SVA and coronal imbalance are major risk factors for the development of adjacent segment pathology (ASP) after lumbar or lumbosacral fusion. 9 , 11 , 21 , 26 , 30 , 37 , 41 , 46 “Adjacent segment pathology” is a general term that refers to any