A systematic review of definitions and classification systems of adjacent segment pathology

Paul Kraemer, Michael G. Fehlings, Robin Hashimoto, Michael J. Lee, Paul A. Anderson, Jens R. Chapman, Annie Raich, Daniel C. Norvell

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Study Design. Systematic review. Objective. To undertake a systematic review to determine how "adjacent segment degeneration," "adjacent segment disease," or clinical pathological processes that serve as surrogates for adjacent segment pathology are classified and defined in the peer-reviewed literature. Summary of Background Data. Adjacent segment degeneration and adjacent segment disease are terms referring to degenerative changes known to occur after reconstructive spine surgery, most commonly at an immediately adjacent functional spinal unit. These can include disc degeneration, instability, spinal stenosis, facet degeneration, and deformity. The true incidence and clinical impact of degenerative changes at the adjacent segment is unclear because there is lack of a universally accepted classification system that rigorously addresses clinical and radiological issues. Methods. A systematic review of the English language literature was undertaken and articles were classified using the Grades of Recommendation Assessment, Development, and Evaluation criteria. Results. Seven classification systems of spinal degeneration, including degeneration at the adjacent segment, were identified. None have been evaluated for reliability or validity specific to patients with degeneration at the adjacent segment. The ways in which terms related to adjacent segment "degeneration" or "disease" are defined in the peer-reviewed literature are highly variable. Conclusion. On the basis of the systematic review presented in this article, no formal classification system for either cervical or thoracolumbar adjacent segment disorders currently exists. Consensus Statement: No recommendations regarding the use of current classification of degeneration at any segments can be made based on the available literature. A new comprehensive definition for adjacent segment pathology (ASP, the now preferred terminology) has been proposed in this Focus Issue, which reflects the diverse pathology observed at functional spinal units adjacent to previous spinal reconstruction and balances detailed stratification with clinical utility. A comprehensive classification system is being developed through expert opinion and will require validation as well as peer review. Strength of Statement: Strong

Original languageEnglish
JournalSpine
Volume37
Issue numberSUPPL. 22
DOIs
StatePublished - Oct 15 2012

Fingerprint

Pathology
Reconstructive Surgical Procedures
Intervertebral Disc Degeneration
Spinal Stenosis
Peer Review
Expert Testimony
Pathologic Processes
Terminology
Reproducibility of Results
Consensus
Spine
Language
Incidence

Keywords

  • adjacent segment degeneration
  • adjacent segment disease
  • adjacent segment pathology
  • cervical spine
  • disc degeneration
  • junctional stenosis
  • lumbar spine
  • revision spine surgery
  • spinal stenosis
  • spine surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Kraemer, P., Fehlings, M. G., Hashimoto, R., Lee, M. J., Anderson, P. A., Chapman, J. R., ... Norvell, D. C. (2012). A systematic review of definitions and classification systems of adjacent segment pathology. Spine, 37(SUPPL. 22). https://doi.org/10.1097/BRS.0b013e31826d7dd6

A systematic review of definitions and classification systems of adjacent segment pathology. / Kraemer, Paul; Fehlings, Michael G.; Hashimoto, Robin; Lee, Michael J.; Anderson, Paul A.; Chapman, Jens R.; Raich, Annie; Norvell, Daniel C.

In: Spine, Vol. 37, No. SUPPL. 22, 15.10.2012.

Research output: Contribution to journalArticle

Kraemer, P, Fehlings, MG, Hashimoto, R, Lee, MJ, Anderson, PA, Chapman, JR, Raich, A & Norvell, DC 2012, 'A systematic review of definitions and classification systems of adjacent segment pathology', Spine, vol. 37, no. SUPPL. 22. https://doi.org/10.1097/BRS.0b013e31826d7dd6
Kraemer, Paul ; Fehlings, Michael G. ; Hashimoto, Robin ; Lee, Michael J. ; Anderson, Paul A. ; Chapman, Jens R. ; Raich, Annie ; Norvell, Daniel C. / A systematic review of definitions and classification systems of adjacent segment pathology. In: Spine. 2012 ; Vol. 37, No. SUPPL. 22.
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