Adjacent Level Disease

1. Adjacent Level Disease

2. What is it? • Mobile spinal levels surrounding a spinal fusion see additional stresses when motion is restricted across the fusion. While it has not been proven, this additional stress is felt to contribute to a higher incidence of degeneration of adjacent segments, which could result in symptoms and the need for additional surgery in the future. This is known as 'adjacent segment disease'. The stress seen by an adjacent level and risk of adjacent segment disease is felt to be progressively higher with more and more levels stiffened by fusion. Therefore, it is thought that multilevel spinal fusions may have a higher risk of adjacent segment disease than single level fusions.

3. How often does it occur? • Slow Process (years) • 25-50% progression on imaging studies in 5 years (Gore and Sepic, Herkowitz et al.) • True rate isn’ known since many patients don’t have follow-up exams if they are doing well. • Clinically all patients may not have symptoms (2.9% annual incidence after surgery) • Re-operation rate of about 10% at 10 years (Mroz et al.)

4. Symptoms • Leg Pain/Cramping • Numbness Tingling • Back Pain • Weakness (Severe cases)

5. Treatments • Observation • Physical Therapy • Steroid Injections • Surgery

6. When to do Surgery • Refractory Symptoms • Weakness • Decreased Quality of life in spite of non-surgical treatments Minimally invasive options may improve recovery with shorter hospital stay and bleeding than traditional approaches.

7. Benign Spinal Cord Tumors

8. What is it? • A spinal tumor is a growth that develops within the spinal canal or within the bones of the spine. A spinal cord tumor, also called an intradural tumor, is a spinal tumor that that begins within the spinal cord or the covering of the spinal cord (dura).

9. Symptoms • Sometimes can be vague • Pain at the site of the tumor due to tumor growth • Back pain, often radiating to other parts of your body • Feeling less sensitive to pain, heat and cold • Loss of bowel or bladder function • Difficulty walking, sometimes leading to falls • Back pain that's worse at night • Loss of sensation or muscle weakness, especially in your arms or legs • Muscle weakness , which may be mild or severe, in different parts of your body

10. Types of tumors • Benign Tumors (often slow-growing with gradual symotoms) • Schwannoma • Neurofibroma • Meningioma • Malignant Tumors (often grow rapidly) • Astrocytoma • Glioma • Ependymoma (can vary in aggressiveness)

11. When to see a Doctor • There are many causes of back pain, and most back pain isn't caused by a tumor. But because early diagnosis and treatment are important for spinal tumors, see your doctor about your back pain if: • It's persistent and progressive • It's not activity related • It gets worse at night • You have a history of cancer and develop new back pain • You have other symptoms of cancer, such as nausea, vomiting or dizziness • Seek immediate medical attention if you experience: • Progressive muscle weakness or numbness in your legs or arms • Changes in bowel or bladder function

12. Diagnosis • MRI with contrast is gold standard • For malignant tumors may need to image other parts of body to look for location of a primary site

13. Treatment • Surgery usually required for large tumors • Depending on tumor type, post-operative radiation may be required.