Adjacent segment disease after instrumented fusion for idiopathic scoliosis: review of current trends and controversies.

STUDY DESIGN

A literature-based review.

OBJECTIVE

To summarize the clinical and morphologic findings leading to diagnosis, the etiologic factors, and principles of management. To identify the strengths and limits of past studies.

SUMMARY OF BACKGROUND DATA

There are considerable controversies regarding etiologic factors, diagnosis, and management of adjacent segment disease in patients instrumented for idiopathic scoliosis.

METHODS

Summarized is past literature and, to some extent, personal experience of the authors.

RESULTS

Several factors participating to this complex pathophysiology are reported. The clinical presentation, occurring after symptom free interval, can vary, and modern morphologic investigations help for diagnosis. Management is often surgical and remains challenging.

CONCLUSIONS

Long-term consequences of spinal fusions are now major concerns, especially in young patients undergoing surgical correction for idiopathic scoliosis. Adjacent segment disease is defined by a combination of clinical symptoms and morphologic findings. Several etiologic factors have been reported, but need to be further studied to prevent and improve the surgical management of this complication.