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

ABSTRACT

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.