• Gregory W Basil, Kolcun John Paul G JPG Department of Neurological Surgery, University of Miami, Miami, Florida, USA., and Michael Y Wang.
• Department of Neurological Surgery, University of Miami, Miami, Florida, USA. Electronic address: gregory.basil@jhsmiami.org.
• World Neurosurg. 2019 Oct 1; 130: 231-234.

BackgroundThe occurrence of adjacent-level disease in spinal fusion is a complex and contentious issue. Through the years, surgeons have developed various approaches to address this problem. While some have avoided fusion altogether, others have advocated for large, multilevel fusion constructs. With the advent of minimally invasive spine surgery, there are now novel approaches to the spine which allow for less onerous and morbid revision surgeries. In this paper, we present the case of a woman who previously underwent a posterior cervical fusion and presented with adjacent-level disease.Case DescriptionA 63-year-old female who had previously undergone a cervical 5 to thoracic 1 posterior instrumented fusion presented with axial neck pain, hand numbness, and imbalance. Imaging demonstrated adjacent-level disease with anterolisthesis of cervical 4 on cervical 5. Rather than exposing her entire fusion construct, we used a new technique to link her old hardware to new instrumentation.ConclusionsWe believe that our case is demonstrative of a new, modularized approach to spinal fusion and suggest a way forward in the treatment of adjacent-level disease.Copyright © 2019 Elsevier Inc. All rights reserved.

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