ADJACENT SEGMENT DISEASE: HOW CAN IT IMPACT YOUR WORKERS’ COMPENSATION CLAIM?
Adjacent segment disease has become a common topic in spine surgery circles because of the significant increase in fusion surgery in recent years. However, in spite of achieving successful fusion in spinal surgery, a long-term follow-up after a solid fusion may reveal degenerative changes including segmental instability, spinal stenosis, intervertebral disc lesion, retro-spondylolisthesis, and fracture at the adjacent segments. For example, an injured worker who required an anterior cervical discectomy and fusion at C5-6 may later develop problems at C4-5 and/or C6-7. Adjacent segment disease (ASDis) is defined as new degenerative changes at a spinal level or levels in the spine, accompanied by related symptoms (radiculopathy, myelopathy, or instability). Adjacent segment degeneration (ASDeg) represents the radiographic changes without the symptomatology.
Adjacent segment disease may arise as a compensable consequential condition. A consequential condition is a condition that is caused as an indirect result of a primary work injury. For example, a worker who sustains a back injury may subsequently develop depression as a result of unremitting pain or disability. For another, a worker with a leg injury may favor the injured leg to such an extent that they develop an injury to the opposite leg. In each case, the second condition is a compensable consequence of the work injury even though the work injury itself played no direct role in causing it. Under Oregon law, such consequential conditions are not compensable unless the compensable injury is the major contributing cause of the consequential condition. ORS 656.005(7)(a). When a consequential condition is claimed under an adjacent segment disease theory, the question is whether the compensable injury would amount to the level of the major contributing cause of the claimed condition.
Some medical studies have found the altered biomechanics at the adjacent levels after fusion may result in increased mobility, increased loading, or increased intradiscal pressure, and ultimately, accelerated disc degeneration. Some suggest soft tissue disruption adjacent to the surgical level is considered a potential cause of ASDeg and subsequent ASDis. Some found incorrect needle placement during intraoperative radiographic-level confirmation increased the relative risk of developing ASDeg.
The takeaway here is that an injured worker should exercise heightened causation when settling his/her works compensation claim following a spinal fusion, because the future complications of the fusion surgery may not be known immediately. The risks associated with potentially developing adjacent segment disease should definitely be factored in when assessing the value of the claim.
Please be advised the materials on this page are for informational purposes only and should not be interpreted as legal advice or opinion.