REVIEW   Free access

Minerva Anestesiologica 2022 April;88(4):282-92

DOI: 10.23736/S0375-9393.21.15939-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Adjacent segment syndrome after failed back surgery: biomechanics, diagnosis, and treatment

Ruben RUBIO-HARO ¹ ✉, Carmen DE ANDRÉS-SERRANO ², David C. NORIEGA GONZÁLEZ ³, Clara BORDES-GARCÍA ⁴, Jose DE ANDRÉS ⁵

¹ Department of Anesthesia, Critical Care and Multidisciplinary Pain Management, University General Hospital of Valencia, Valencia, Spain; ² Multidisciplinary Pain Clinic, Vithas Virgen del Consuelo Hospital, Valencia, Spain; ³ Column Unit, Orthopedic Surgery Service, University Clinic Hospital of Valladolid, Valladolid, Spain; ⁴ Department of Anesthesia Critical Care and Pain Management, Vall d’Hebron Hospital, Barcelona, Spain; ⁵ Department of Anesthesia Critical Care and Pain Management, Valencia University General Hospital, Medical School, University of Valencia, Valencia, Spain

The adjacent segment syndrome is defined as the changes in the adjacent structures of an operated spinal level that produce symptoms of pain and disability, which worsen the quality of life of a patient. Pain management specialists must be aware of these biomechanical changes brought by spinal surgeries, as well as of the symptoms associated with pain after surgery, to reach an appropriate diagnosis and provide an adequate treatment. Specialized pain literature contains few reports on specific management of patients using the terms “adjacent segment syndrome, degeneration or disease;” most of the literature comes from surgical journals. It is necessary to perform studies with a population sample comprising patients with adjacent segment syndrome after spinal surgery, since almost all treatments applied in this group are extrapolated from those used in patients with pain originating in the same area but who have not previously undergone spine surgery. Therefore, we consider necessary for pain physicians to understand the underlying biomechanics, promote the diagnosis of this condition, and analyze possible treatments in patients with adjacent segment disease to alleviate their pain and improve their quality of life.

KEY WORDS: Cervical vertebrae; Ossification, heterotopic; Intervertebral disc; Lumbar vertebrae; Zygapophyseal joint