Adjacent level degeneration in the c-spine

fortitudine · #1 (**permalink**) 10-04-2009, 08:37 PM

This is a continuation of some comments made on Steve55's thread. I didn't want to hijack it, so I've started this new one. The comments about adjacent level probelms at c1/2/3 not being very likely interested me greatly.

That's because my NS here wants to fuse c2/3 even though it is perfectly fine, because it is next to 3/4/5 which he says need to be fused. When I queried him about the 2/3 he said he'd do it because it would probably go and it would be easier to do them all at once than have to go back and do 2/3 on its own.

It was 5 years ago that he told me that, perhaps recent research has revealed that 2/3 isn't likely to go?

steve55 · #2 (**permalink**) 10-05-2009, 04:15 AM

Goodness, he must have had reason to think it would go. It makes no sense for surgeon to fuse a perfectly healthy disc unless it already was looking compromised at that time. In that case, he could have made the same arguement for the lower adjacent level also. These c1/2 & c2/3 areas do go bad also, its just that they are just much less likely to.

So, did the c2/3 fusion result in much loss of Range of motion? Ive heard that the c1/2 and c2/3 are responsible for most of the ROM.

mmglobal · #3 (**permalink**) 10-05-2009, 05:01 AM

With ADR, it's easier to consider leaving a suspect level next to a still moving segment; than it is to consider leaving it next to a fusion. Fusion next to an already damaged disc will speed the degeration. ADR next to the already damaged disc may actually slow it down if it restores more natural kinematics, thus reducing the 'overload' of the adjacent segment that is increased by the poor motion.

We all know that fusion does not guarantee adjacent level disease.

We also know that ADR does not guarantee against adjacent segment disease.

Nobody knows what the timeline is. It's hard to imaging taking a healthy segment prophylactically... just because it may go at some time in the future.

This is especially true in the cervical spine where repeat surgeries are not nearly as difficult to consider as they are in the lumbar spine.

Mark

ans · #4 (**permalink**) 10-06-2009, 05:31 AM

Feh! Propylactic fusion!

Adjacent segment disorder has affected my life as I have extensive DDD from L2-S1.

Good luck people.

Now, there should be someone who wins the Nobel for preventing this!

fortitudine · #5 (**permalink**) 10-07-2009, 03:39 AM

My NS wanted to fuse the non-involved 2/3 because he said it would be very difficult to get at later after 2/3/4 were fused posteriorly with hardware.
I said no.

Found Dr. B who did NOT recommend such drastic measures. But I'm holding my own in the neck department.

Katie · #6 (**permalink**) 10-07-2009, 03:50 AM

I had the opposite problem. More than one of the best doctors I've been to wanted to do work on both C4/5 & 5/6, but the present one only wants to do ADR on C5/6, despite the fact that the 4/5 is already moderately compressed.

I wish we could get these specialists together and have them agree on something.