Abstract

Background: Adjacent segment (AS) pathology is a commonly observed complication after spinal arthrodesis, characterized by degeneration and/or device failure of the segments adjacent to the fusion. These pathologies 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 pathology 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 decompression and osteosynthesis for a narrow lumbar canal. Imagery workup showed hardware loosening, a screw malposition and new junctional kyphosis. The surgery consisted of lengthening decompression 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, mJOA score = 5, 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, ASP 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.

Keywords

: adjacent segment pathology, complication, arthrodesis, spine surgery