Cervical adjacent segment disease Pathology Degenerative Subgroup Cervical

Cervical adjacent segment disease • Pathology: Degenerative • Subgroup: Cervical spondylosis Copyright © by AOSpine International. Check hazards and legal restrictions on www. aospine. org/disclaimers. aspx

• 54 -year-old woman • Anterior cervical discectomy and fusion (ACDF) of C 6/7 5 years previously • 6 -month history of increasing neck pain with occipital headaches and “heavy head” sensation • 6 -week history of progressive left deltoid weakness (grade 2) • Inability to abduct left arm against gravity • Deltoid/scapular wasting/scalloping • No long tract signs

Preoperative AP and lateral x-rays Previous anterior cervical discectomy and fusion

Sagittal MRI showing C 4/5 disc/osteophyte impingement

Axial MRI at C 4/5 L

Preoperative postmyelogram CT scans

Postoperative AP and later x-rays

Summary • Adjacent segment disease after anterior cervical discectomy and fusion presents with both mechanical and neurological symptoms • C 4/5 uncovertebral osteophytes responsible for left C 5 radiculopathy • CT myelogram most accurately reflects degree of compression on neural root • Central stenosis may be minimal • Surgical options include anterior or posterior decompression, depending on degree of mechanical symptoms • Restoration of disc height indirectly decompresses foramen and exiting nerve root

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