1101 - Delayed recognition of adjacent segment disease resulting in cervical myelopathy: a case report

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

MF

Michael Franco, MD

Resident
Mayo Clinic Rochester
Byron, Minnesota, United States

Co-Author(s)

RR

Ronald Reeves, MD

Associate Professor of Physical Medicine and Rehabilitation
Mayo Clinic
Rochester, Minnesota, United States
AG

Alyssa Golden-Hart, DO

Resident
Mayo Clinic
Rochester, Minnesota, United States
DT

Danyal Tahseen, B.S.

Medical Student
Sam Houston State University
Rosenberg, Texas, United States

Submitter(s)

MF

Michael Franco, MD

Mayo Clinic Rochester
Byron, Minnesota, United States

Case Diagnosis: Adjacent segment disease (ASD) is a significant long-term complication of cervical spine fusion procedures. Symptomatic disease develops in approximately 1.6–4.2% of patients annually, with cumulative rates reaching 13–25% at 10 years postoperatively. A 66-year-old woman with a history of anterior cervical discectomy and fusion at C5–7 developed gradually progressive bilateral upper extremity radicular symptoms, right leg weakness, and sphincter disturbances 24 years after her initial operation.

Case Description:

In February 2024, the patient began experiencing progressive bilateral hand numbness, weakness, and radicular pain, followed by right leg weakness precipitating gait instability and falls over subsequent months. Symptoms progressed, requiring a cane, indoor walker, and outdoor wheelchair. Bowel and bladder incontinence emerged in the spring of 2025, and an MRI was finally obtained in July of 2025. Imaging revealed severe canal stenosis at C4–5 and foraminal narrowing at C3–4 and C4–5. She underwent a C3–6 posterior decompression and fusion and was admitted to inpatient rehabilitation once stable. Following a 14-day stay she was discharged home independent with a walker and adaptive equipment.

Discussions:

ASD is a well-recognized complication of cervical fusion, yet progression was unrecognized until significant neurological impairment occurred. In this case, our patient began to experience clear symptoms of cervical radiculopathy that progressed to myelopathy 16 months before a cervical MRI was ordered to make the diagnosis. The patient was seen on several occasions, however no one was able to localize the problem to the cervical spine. Professional education to raise awareness of ASD among primary care providers could help prevent delayed recognition as occurred in this case.

Conclusions:

Delayed recognition of ASD can lead to prolonged patient suffering and neurologic decline. A high index of suspicion, particularly in patients with prior cervical fusion, can prompt timely imaging, early diagnosis, and improved recovery.