Adjacent Segment Syndrome: Case Study and Management at Niamey National Hospital

Adjacent Segment Syndrome: Case Study and Management at Niamey National Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Adjacent Segment Syndrome: Case Study and Management at Niamey National Hospital Chaibou Sodé Haboubacar, Sawa Nouga Brice Audrey, Hassan Maman Laoul, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6874386/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Adjacent segment (AS) syndrome is a commonly observed complication after spinal arthrodesis, characterized by degeneration of the segments adjacent to the fusion. This pathology can lead to severe complications, including pain, neurological deficits, and surgical reinterventions. There is no literature on such pathology in Sub-Saharan Africa. We report two cases of adjacent segment degeneration cared for at Niamey National Hospital, focusing on diagnosis, treatment, and outcome. Case description Patient 1–65 years old male admitted for cauda equina syndrome, three years after lumbar recalibration and osteosynthesis for a narrow lumbar canal. Imagery workup showed disassembly of osteosynthesis, a screw malposition and neo kyphosis. The surgery consisted of lengthening recalibration and readjusting the osteosynthesis prolonged up to D12. The outcome was satisfactory after physiotherapeutic rehabilitation, with free-of-event follow-up. Patient 2–62 years old female admitted for cervical cord compression syndrome, Frankel B with polypnea, 6 months after C4-C5 ACDF. The cervical CT scan revealed a C2-C3 listhesis with 50% cervical canal reduction, responsible for cord compression. She went on cervical traction for resuscitation and, unfortunately, could not survive to benefit from the surgery. Conclusions Though a rare complication, ASD should be considered, especially when the factors described in the literature are encountered. This should be part of the surgical planning to avoid further complications and ensure the long-term well-being of the patients. adjacent segment syndrome complication arthrodesis spine surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Vertebral arthrodesis is a common procedure in the treatment of degenerative spinal pathologies. However, this fusion sometimes leads to complications, including adjacent segment pathology (ASP). Adjacent segment degeneration (ASDeg) includes a wide range of pathologies: listhesis, disc herniation, stenosis, hypertrophic facet arthritis, scoliosis, and vertebral compression fractures. Thes pathologies mostly have a clinical expression called adjacent segment disease (ASDis) or adjacent segment syndrome (ASD) [ 1 , 2 ]. These disorders often occur after spinal stabilization and are associated with various risk factors [ 3 – 7 ]. This clinical entity hasn’t been met yet in sub-Saharan literature. This study aims to describe the management of AS at Niamey National Hospital by analyzing two clinical cases following CARE guidelines. CASE PRESENTATION Patient 1 ( Fig. 1 ) Surgical history and clinical presentation A 65-year-old patient with no significant past medical history presented in 2023 with neurogenic claudication with polyradiculalgia. The diagnosis of narrow lumbar canal was made by computed tomography (CT) and magnetic resonance imaging (MRI), and the patient underwent surgery consisting of recalibration of the lumbar spine by laminectomy from L2 to S1 with rod fixation and polyaxial L2-S1 screws (Fig. 2 ). Post-operative evolution was straightforward, with the resumption of professional activities. Three years after surgery, the patient consulted for polyradiculalgia, difficulty in the supine position, as well as para-paresis, flaccid hypotonia, saddle hypoesthesia, and urinary retention associated with erectile dysfunction. Diagnosis assessment A radiograph of the lumbar spine revealed disassembly of the proximal osteosynthesis, with migration of two screws from L2 and a L1-L2 neo-kyphosis (Fig. 3A and 3B). A CT scan of the lumbar spine revealed a right pedicle fracture of L2 with canal intrusion of the left screw (Fig. 4 ). Surgical management and outcome The patient was reoperated; the procedure consisted in removing the defective screws and inserting new screws and rods at L1, thus lengthening the set-up. On Day 1, the patient was sitting and began walking with assistance on Day 2. Physiotherapy rehabilitation was initiated, with satisfactory results. A follow-up lumbar X-ray showed the osteosynthesis hardware in place (Fig. 5A and 5B). Patient 2 ( Fig. 1 ) Surgical history and clinical presentation A 62-year-old female patient, whose past medical history included a herniated C4-C5 cervical disc on a degenerative cervical spine, for which she underwent a C4-C5 discectomy, plus iliac graft with C4-C5 osteosynthesis. Six months after surgery, she presented with a worsening of her neurological condition. Admission examination revealed Frankel B tetraplegia with neurovegetative signs such as polypnea. Diagnosis assessment A CT scan of the cervical spine revealed a C2-C3 listhesis of around 50%, responsible for spinal cord compression. Emergency treatment and outcome The patient was admitted to resuscitation with transcranial traction for stabilization. Unfortunately, she died the following day. DISCUSSIONS AND CONCLUSION Adjacent segment (AS) syndrome is a frequent complication after spinal arthrodesis. Radiological evidence of adjacent segment degeneration is common, but association with clinical symptoms (adjacent segment disease) are less frequent [ 1 ]. According to a review of the literature by Park et al. [ 8 ], radiological adjacent segment degeneration after lumbar arthrodesis varies from 5–100%, while clinical symptoms occur in 5–18% of cases. In our context, the absence of clinical symptoms in many patients and the lack of regular follow-up contribute to the late management of AS. Studies have shown that adjacent segment pathology increases with time, reaching 36.1% of patients 10 years after lumbar arthrodesis [ 9 ]. Some risk factors have been described by Nakajima et al. [ 4 ], as influencing the early onset of ASDeg in lumbar spine surgery. In our two cases, the onset of the complication was relatively fast, with a timeframe of three years for the first patient and six months for the second patient. The intensity of the symptoms might explain why our patients consulted early. There was not a substantial study of pre op imageries to identify some of the risk factors described in the literature. The risk of adjacent segment pathology is particularly high in patients with degenerative spondylolisthesis [ 3 ]. In addition, factors such as pre-existing horizontalization of the lamina and facet tropism appear to influence the onset of AS [ 7 ]. Other factors, such as a high number of instrumented vertebrae and preoperative sagittal imbalance, have also been implicated in the pathogenesis of AS [ 3 , 6 , 10 ]. Adjacent segment (AS) syndrome remains a worrying long-term complication after spinal fusion. Although it can be managed with conservative therapies, appropriate surgical management may be necessary in some cases. Prevention requires analysis of pre op imageries, careful selection of surgical techniques and effective post-operative rehabilitation. Long-term monitoring of patients is crucial to detect early degradation of adjacent segments and to avoid repeated surgeries. An extended study in our settlement is needed to appreciate the incidence and look after risks factors as far as spine surgery is common. Abbreviations ACDF Anterior Cervical Discectomy and Fusion AS Adjacent segment Syndrome ASP Adjacent Segment Pathology ASDis Adjacent Segment Disease ASDeg Adjacent Segment Degeneration CT Computerized Tomography Declarations Ethics approval Ethics approval was provided by the Niamey National Hospital Board. Clinical Trial Number Not applicable Consent for publication The first patient and the carer of the second patient gave each a written informed consent for publication of their clinical details along with any identifying images for this study. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests There is no competing interest in this manuscript Funding This study was not funded. Authors’ contributions CHS: design of the work, acquisition and interpretation of data, bibliography review, drafting of the manuscript. SNBA: bibliography review, drafting of the manuscript, HML: revision of the manuscript AII: revision of the manuscript MSAZ: revision of the manuscript IHNR: revision of the manuscript AH: revision of the manuscript HN: revision of the manuscript AK: revision of the manuscript, supervision of the work. All the authors read and approved the final manuscript. Acknowledgements Not applicable. References Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J. 2004;4:S190–4. Moreau P-E, Ferrero E, Riouallon G, et al. Dégradation radiologique du segment adjacent au recul moyen de 2 ans d’une fusion lombaire pour spondylolisthésis dégénératifs. Revue de Chirurgie Orthopédique et Traumatologique. 2016;102:558–62. Lee CS, Hwang CJ, Lee S-W, et al. Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J. 2009;18:1637–43. Nakajima H, Watanabe S, Honjoh K, et al. Risk factors for early-onset adjacent segment degeneration after one-segment posterior lumbar interbody fusion. Sci Rep. 2024;14:9145. Chung JY, Park J-B, Seo H-Y, et al. Adjacent Segment Pathology after Anterior Cervical Fusion. Asian Spine J. 2016;10:582–92. Zhang Y, Shao Y, Liu H, et al. Association between sagittal balance and adjacent segment degeneration in anterior cervical surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019;20:430. Okuda S, Oda T, Miyauchi A, et al. Lamina horizontalization and facet tropism as the risk factors for adjacent segment degeneration after PLIF. Spine (Phila Pa 1976). 2008;33:2754–8. Park P, Garton HJ, Gala VC, et al. Adjacent Segment Disease after Lumbar or Lumbosacral Fusion: Review of the Literature. Spine. 2004;29:1938. Ghiselli G, Wang JC, Bhatia NN, et al. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am. 2004;86:1497–503. Etchart P. Rôle de l’équilibre sagittal dans la survenue du syndrome du segment adjacent après arthrodèse rachidienne. 2017; 66. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6874386","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":496427875,"identity":"d3173c14-e91d-494c-b8b7-01be172496b2","order_by":0,"name":"Chaibou Sodé Haboubacar","email":"","orcid":"","institution":"Health Sciences Modern University","correspondingAuthor":false,"prefix":"","firstName":"Chaibou","middleName":"Sodé","lastName":"Haboubacar","suffix":""},{"id":496427876,"identity":"d48bfad2-f7d1-4681-b6b1-449a8724202f","order_by":1,"name":"Sawa Nouga Brice 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18:53:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6874386/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6874386/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88527972,"identity":"59f47d23-401e-444a-afd2-0f44077f013f","added_by":"auto","created_at":"2025-08-07 10:49:22","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":51061,"visible":true,"origin":"","legend":"\u003cp\u003etimeline of historical, clinic and care information for both cases.\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6874386/v1/79089deabdf793ab6c6fc6af.jpg"},{"id":88527631,"identity":"a2013747-ee9f-44a2-abcb-1eed36ed059b","added_by":"auto","created_at":"2025-08-07 10:41:22","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":80428,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative radiograph of initial osteosynthesis.\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6874386/v1/70edf802a68d92bbdb2609b6.jpg"},{"id":88526322,"identity":"df0b139e-a94e-4ebb-9286-162d13a56e3c","added_by":"auto","created_at":"2025-08-07 10:33:22","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":63918,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA:\u003c/strong\u003eFront X-ray showing the overlying disc disease of the proximal intra-disc screw assembly.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB:\u003c/strong\u003eLateral X-ray showing the overlying discopathy of the proximal intradiscal screw assembly.\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6874386/v1/83eddda13375fa3e5dc577fe.jpg"},{"id":88526324,"identity":"506fe3cf-0b3f-4bbe-bb9a-510c6b50bbae","added_by":"auto","created_at":"2025-08-07 10:33:22","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":125404,"visible":true,"origin":"","legend":"\u003cp\u003eAxial CT scan of the L2 vertebra, showing the right pedicle fracture with intrusion of the left screw into the vertebrae canal.\u003c/p\u003e","description":"","filename":"Picture4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6874386/v1/17532707380dcfc498f186b1.jpg"},{"id":88527632,"identity":"5600320a-71b6-45e7-a8e4-926b57db6e94","added_by":"auto","created_at":"2025-08-07 10:41:22","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":85658,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA:\u003c/strong\u003eFront X-ray showing the new assembly beyond the disc disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB:\u003c/strong\u003eLateral X-ray showing the new mounting beyond the affected disc and correction of the neo-kyphosis.\u003c/p\u003e","description":"","filename":"Picture5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6874386/v1/56e6c60dd01e434b8aac6cf0.jpg"},{"id":90386140,"identity":"982219cd-f08c-49d7-bf0b-9882e874d016","added_by":"auto","created_at":"2025-09-02 07:32:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":933701,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6874386/v1/6a9ba7c6-e956-4f02-abb7-4e9786b10484.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adjacent Segment Syndrome: Case Study and Management at Niamey National Hospital","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eVertebral arthrodesis is a common procedure in the treatment of degenerative spinal pathologies. However, this fusion sometimes leads to complications, including adjacent segment pathology (ASP). Adjacent segment degeneration (ASDeg) includes a wide range of pathologies: listhesis, disc herniation, stenosis, hypertrophic facet arthritis, scoliosis, and vertebral compression fractures. Thes pathologies mostly have a clinical expression called adjacent segment disease (ASDis) or adjacent segment syndrome (ASD) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These disorders often occur after spinal stabilization and are associated with various risk factors [\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This clinical entity hasn\u0026rsquo;t been met yet in sub-Saharan literature. This study aims to describe the management of AS at Niamey National Hospital by analyzing two clinical cases following CARE guidelines.\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003e\u003cb\u003ePatient 1 (\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSurgical history and clinical presentation\u003c/strong\u003e\u003cp\u003eA 65-year-old patient with no significant past medical history presented in 2023 with neurogenic claudication with polyradiculalgia. The diagnosis of narrow lumbar canal was made by computed tomography (CT) and magnetic resonance imaging (MRI), and the patient underwent surgery consisting of recalibration of the lumbar spine by laminectomy from L2 to S1 with rod fixation and polyaxial L2-S1 screws (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Post-operative evolution was straightforward, with the resumption of professional activities.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eThree years after surgery, the patient consulted for polyradiculalgia, difficulty in the supine position, as well as para-paresis, flaccid hypotonia, saddle hypoesthesia, and urinary retention associated with erectile dysfunction.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDiagnosis assessment\u003c/strong\u003e\u003cp\u003eA radiograph of the lumbar spine revealed disassembly of the proximal osteosynthesis, with migration of two screws from L2 and a L1-L2 neo-kyphosis (Fig.\u0026nbsp;3A and 3B). A CT scan of the lumbar spine revealed a right pedicle fracture of L2 with canal intrusion of the left screw (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSurgical management and outcome\u003c/strong\u003e\u003cp\u003eThe patient was reoperated; the procedure consisted in removing the defective screws and inserting new screws and rods at L1, thus lengthening the set-up. On Day 1, the patient was sitting and began walking with assistance on Day 2. Physiotherapy rehabilitation was initiated, with satisfactory results. A follow-up lumbar X-ray showed the osteosynthesis hardware in place (Fig.\u0026nbsp;5A and 5B).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePatient 2 (\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSurgical history and clinical presentation\u003c/strong\u003e\u003cp\u003eA 62-year-old female patient, whose past medical history included a herniated C4-C5 cervical disc on a degenerative cervical spine, for which she underwent a C4-C5 discectomy, plus iliac graft with C4-C5 osteosynthesis.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eSix months after surgery, she presented with a worsening of her neurological condition.\u003c/p\u003e\u003cp\u003eAdmission examination revealed Frankel B tetraplegia with neurovegetative signs such as polypnea.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDiagnosis assessment\u003c/strong\u003e\u003cp\u003eA CT scan of the cervical spine revealed a C2-C3 listhesis of around 50%, responsible for spinal cord compression.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEmergency treatment and outcome\u003c/strong\u003e\u003cp\u003eThe patient was admitted to resuscitation with transcranial traction for stabilization. Unfortunately, she died the following day.\u003c/p\u003e\u003c/p\u003e"},{"header":"DISCUSSIONS AND CONCLUSION","content":"\u003cp\u003eAdjacent segment (AS) syndrome is a frequent complication after spinal arthrodesis. Radiological evidence of adjacent segment degeneration is common, but association with clinical symptoms (adjacent segment disease) are less frequent [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to a review of the literature by Park et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], radiological adjacent segment degeneration after lumbar arthrodesis varies from 5\u0026ndash;100%, while clinical symptoms occur in 5\u0026ndash;18% of cases. In our context, the absence of clinical symptoms in many patients and the lack of regular follow-up contribute to the late management of AS.\u003c/p\u003e\u003cp\u003eStudies have shown that adjacent segment pathology increases with time, reaching 36.1% of patients 10 years after lumbar arthrodesis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Some risk factors have been described by Nakajima et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], as influencing the early onset of ASDeg in lumbar spine surgery. In our two cases, the onset of the complication was relatively fast, with a timeframe of three years for the first patient and six months for the second patient. The intensity of the symptoms might explain why our patients consulted early. There was not a substantial study of pre op imageries to identify some of the risk factors described in the literature.\u003c/p\u003e\u003cp\u003eThe risk of adjacent segment pathology is particularly high in patients with degenerative spondylolisthesis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In addition, factors such as pre-existing horizontalization of the lamina and facet tropism appear to influence the onset of AS [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Other factors, such as a high number of instrumented vertebrae and preoperative sagittal imbalance, have also been implicated in the pathogenesis of AS [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdjacent segment (AS) syndrome remains a worrying long-term complication after spinal fusion. Although it can be managed with conservative therapies, appropriate surgical management may be necessary in some cases. Prevention requires analysis of pre op imageries, careful selection of surgical techniques and effective post-operative rehabilitation. Long-term monitoring of patients is crucial to detect early degradation of adjacent segments and to avoid repeated surgeries. An extended study in our settlement is needed to appreciate the incidence and look after risks factors as far as spine surgery is common.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eACDF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAnterior Cervical Discectomy and Fusion\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdjacent segment Syndrome\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eASP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdjacent Segment Pathology\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eASDis\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdjacent Segment Disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eASDeg\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdjacent Segment Degeneration\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComputerized Tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was provided by the Niamey National Hospital Board.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe first patient and the carer of the second patient gave each a written informed consent for publication of their clinical details along with any identifying images for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no competing interest in this manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not funded.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCHS:\u003c/strong\u003e design of the work, acquisition and interpretation of data, bibliography review, drafting of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSNBA:\u003c/strong\u003e bibliography review, drafting of the manuscript,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHML:\u003c/strong\u003e revision of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAII:\u003c/strong\u003e revision of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMSAZ:\u003c/strong\u003e revision of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIHNR:\u003c/strong\u003e revision of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAH:\u003c/strong\u003e revision of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHN:\u003c/strong\u003e revision of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAK:\u003c/strong\u003e revision of the manuscript, supervision of the work.\u003c/p\u003e\n\u003cp\u003eAll the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J. 2004;4:S190\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoreau P-E, Ferrero E, Riouallon G, et al. D\u0026eacute;gradation radiologique du segment adjacent au recul moyen de 2 ans d\u0026rsquo;une fusion lombaire pour spondylolisth\u0026eacute;sis d\u0026eacute;g\u0026eacute;n\u0026eacute;ratifs. Revue de Chirurgie Orthop\u0026eacute;dique et Traumatologique. 2016;102:558\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee CS, Hwang CJ, Lee S-W, et al. Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J. 2009;18:1637\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNakajima H, Watanabe S, Honjoh K, et al. Risk factors for early-onset adjacent segment degeneration after one-segment posterior lumbar interbody fusion. Sci Rep. 2024;14:9145.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChung JY, Park J-B, Seo H-Y, et al. Adjacent Segment Pathology after Anterior Cervical Fusion. Asian Spine J. 2016;10:582\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang Y, Shao Y, Liu H, et al. Association between sagittal balance and adjacent segment degeneration in anterior cervical surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019;20:430.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOkuda S, Oda T, Miyauchi A, et al. Lamina horizontalization and facet tropism as the risk factors for adjacent segment degeneration after PLIF. Spine (Phila Pa 1976). 2008;33:2754\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePark P, Garton HJ, Gala VC, et al. Adjacent Segment Disease after Lumbar or Lumbosacral Fusion: Review of the Literature. Spine. 2004;29:1938.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhiselli G, Wang JC, Bhatia NN, et al. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am. 2004;86:1497\u0026ndash;503.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEtchart P. R\u0026ocirc;le de l\u0026rsquo;\u0026eacute;quilibre sagittal dans la survenue du syndrome du segment adjacent apr\u0026egrave;s arthrod\u0026egrave;se rachidienne. 2017; 66.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"adjacent segment syndrome, complication, arthrodesis, spine surgery","lastPublishedDoi":"10.21203/rs.3.rs-6874386/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6874386/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdjacent segment (AS) syndrome is a commonly observed complication after spinal arthrodesis, characterized by degeneration of the segments adjacent to the fusion. This pathology can lead to severe complications, including pain, neurological deficits, and surgical reinterventions. There is no literature on such pathology in Sub-Saharan Africa. We report two cases of adjacent segment degeneration cared for at Niamey National Hospital, focusing on diagnosis, treatment, and outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase description\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePatient 1–65\u003c/em\u003e years old male admitted for cauda equina syndrome, three years after lumbar recalibration and osteosynthesis for a narrow lumbar canal. Imagery workup showed disassembly of osteosynthesis, a screw malposition and neo kyphosis. The surgery consisted of lengthening recalibration and readjusting the osteosynthesis prolonged up to D12. The outcome was satisfactory after physiotherapeutic rehabilitation, with free-of-event follow-up. \u003cem\u003ePatient 2–62\u003c/em\u003e years old female admitted for cervical cord compression syndrome, Frankel B with polypnea, 6 months after C4-C5 ACDF. The cervical CT scan revealed a C2-C3 listhesis with 50% cervical canal reduction, responsible for cord compression. She went on cervical traction for resuscitation and, unfortunately, could not survive to benefit from the surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThough a rare complication, ASD should be considered, especially when the factors described in the literature are encountered. This should be part of the surgical planning to avoid further complications and ensure the long-term well-being of the patients.\u003c/p\u003e","manuscriptTitle":"Adjacent Segment Syndrome: Case Study and Management at Niamey National Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-07 10:33:17","doi":"10.21203/rs.3.rs-6874386/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"211a5a43-974c-4a09-be35-1b31fea471a5","owner":[],"postedDate":"August 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-02T07:24:43+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-07 10:33:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6874386","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6874386","identity":"rs-6874386","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}