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Accelerated Degeneration
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          TERMINOLOGY

          • Synonyms

            • Spinal "transitional" degenerative syndrome, accelerated segmental degeneration
            • Adjacent segment degeneration
          • Definitions

            • Accelerated degeneration of disc space/facets at level(s) adjacent to surgical fusion

          IMAGING

          • General Features

            • Radiographic Findings

              • Fluoroscopic Findings

                • CT Findings

                  • MR Findings

                    • Nonvascular Interventions

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                Selected References

                                                1. Celestre PC et al: Lumbar clinical adjacent segment pathology: predilection for proximal levels. Spine (Phila Pa 1976). 39(2):172-6, 2014
                                                2. Nunley PD et al: Factors affecting the incidence of symptomatic adjacent level disease in cervical spine after total disc arthroplasty: 2-4 years follow-up of 3 prospective randomized trials. Spine (Phila Pa 1976). Epub ahead of print, 2011
                                                3. Schoenfeld AJ: Adjacent segment degeneration after lumbar spinal fusion: risk factors and implications for clinical practice. Spine J. 11(1):21-3, 2011
                                                4. Ekman P et al: A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration. Eur Spine J. 18(8):1175-86, 2009
                                                5. Lee CS et al: Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J. 18(11):1637-43, 2009
                                                6. Hadjipavlou AG et al: The pathophysiology of disc degeneration: a critical review. J Bone Joint Surg Br. 90(10):1261-70, 2008
                                                7. Kumar A et al: Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after two years. Spine (Phila Pa 1976). 33(26):2909-14, 2008
                                                8. Gertzbein SD et al: Disc herniation after lumbar fusion. Spine. 27(16):E373-6, 2002
                                                9. Iseda T et al: Serial changes in signal intensities of the adjacent discs on T2-weighted sagittal images after surgical treatment of cervical spondylosis: anterior interbody fusion versus expansive laminoplasty. Acta Neurochir (Wien). 143(7):707-10, 2001
                                                10. Eck JC et al: Adjacent-segment degeneration after lumbar fusion: a review of clinical, biomechanical, and radiologic studies. Am J Orthop. 28(6):336-40, 1999
                                                11. Balderston RA et al: Magnetic resonance imaging analysis of lumbar disc changes below scoliosis fusions. A prospective study. Spine. 23(1):54-8; discussion 59, 1998
                                                12. Hambly MF et al: The transition zone above a lumbosacral fusion. Spine. 23(16):1785-92, 1998
                                                13. Chow DH et al: Effects of short anterior lumbar interbody fusion on biomechanics of neighboring unfused segments. Spine. 21(5):549-55, 1996
                                                14. Wu W et al: Degenerative changes following anterior cervical discectomy and fusion evaluated by fast spin-echo MR imaging. Acta Radiol. 37(5):614-7, 1996
                                                15. Penta M et al: Magnetic resonance imaging assessment of disc degeneration 10 years after anterior lumbar interbody fusion. Spine. 20(6):743-7, 1995
                                                16. Kim YE et al: Effect of disc degeneration at one level on the adjacent level in axial mode. Spine. 16(3):331-5, 1991
                                                17. Lee CK: Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine. 13(3):375-7, 1988
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        TERMINOLOGY

                                                        • Synonyms

                                                          • Spinal "transitional" degenerative syndrome, accelerated segmental degeneration
                                                          • Adjacent segment degeneration
                                                        • Definitions

                                                          • Accelerated degeneration of disc space/facets at level(s) adjacent to surgical fusion

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • Fluoroscopic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Nonvascular Interventions

                                                                    • Nuclear Medicine Findings

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Gross Pathologic & Surgical Features

                                                                                • Microscopic Features

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              Selected References

                                                                                              1. Celestre PC et al: Lumbar clinical adjacent segment pathology: predilection for proximal levels. Spine (Phila Pa 1976). 39(2):172-6, 2014
                                                                                              2. Nunley PD et al: Factors affecting the incidence of symptomatic adjacent level disease in cervical spine after total disc arthroplasty: 2-4 years follow-up of 3 prospective randomized trials. Spine (Phila Pa 1976). Epub ahead of print, 2011
                                                                                              3. Schoenfeld AJ: Adjacent segment degeneration after lumbar spinal fusion: risk factors and implications for clinical practice. Spine J. 11(1):21-3, 2011
                                                                                              4. Ekman P et al: A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration. Eur Spine J. 18(8):1175-86, 2009
                                                                                              5. Lee CS et al: Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J. 18(11):1637-43, 2009
                                                                                              6. Hadjipavlou AG et al: The pathophysiology of disc degeneration: a critical review. J Bone Joint Surg Br. 90(10):1261-70, 2008
                                                                                              7. Kumar A et al: Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after two years. Spine (Phila Pa 1976). 33(26):2909-14, 2008
                                                                                              8. Gertzbein SD et al: Disc herniation after lumbar fusion. Spine. 27(16):E373-6, 2002
                                                                                              9. Iseda T et al: Serial changes in signal intensities of the adjacent discs on T2-weighted sagittal images after surgical treatment of cervical spondylosis: anterior interbody fusion versus expansive laminoplasty. Acta Neurochir (Wien). 143(7):707-10, 2001
                                                                                              10. Eck JC et al: Adjacent-segment degeneration after lumbar fusion: a review of clinical, biomechanical, and radiologic studies. Am J Orthop. 28(6):336-40, 1999
                                                                                              11. Balderston RA et al: Magnetic resonance imaging analysis of lumbar disc changes below scoliosis fusions. A prospective study. Spine. 23(1):54-8; discussion 59, 1998
                                                                                              12. Hambly MF et al: The transition zone above a lumbosacral fusion. Spine. 23(16):1785-92, 1998
                                                                                              13. Chow DH et al: Effects of short anterior lumbar interbody fusion on biomechanics of neighboring unfused segments. Spine. 21(5):549-55, 1996
                                                                                              14. Wu W et al: Degenerative changes following anterior cervical discectomy and fusion evaluated by fast spin-echo MR imaging. Acta Radiol. 37(5):614-7, 1996
                                                                                              15. Penta M et al: Magnetic resonance imaging assessment of disc degeneration 10 years after anterior lumbar interbody fusion. Spine. 20(6):743-7, 1995
                                                                                              16. Kim YE et al: Effect of disc degeneration at one level on the adjacent level in axial mode. Spine. 16(3):331-5, 1991
                                                                                              17. Lee CK: Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine. 13(3):375-7, 1988