Medical Necessity of Surgical Intervention for Adjacent Segment Disease

Patient Presentation and Clinical Findings

A 38-year-old male patient presents with increasing left-sided neck pain radiating to the left parietal occipital region, posterior triceps, and axillary region, with pain levels of 6-7/10 daily, reaching 9/10 after work shifts, associated with severe migraines 1
The patient has a history of traumatic cervical disc herniation at C6-7 with previous ACDF, now presenting with adjacent segment disease at C5-6 2
Physical exam shows positive Spurling maneuvers bilaterally eliciting left-sided neck pain 2
The patient has attempted conservative management including physical therapy, spine injections, home therapy, and oral medications 2

MRI shows C5-6 mild disc space narrowing with bulging annulus and central protruding disc herniation abutting the cord 2
MRI also confirms mild narrowing of the central canal and right foramen at C5-6 2
X-ray demonstrates minimal DDD at C5-6 and moderate left side foraminal narrowing at C6-7 2

ACDF is recommended for cervical radiculopathy when conservative management has failed and imaging demonstrates neural compression corresponding with clinical findings 2
The patient has documented signs of neural compression with radicular symptoms correlating with the C5-6 level shown on imaging 2
For 1-level cervical disc degeneration, ACDF is recommended over ACD for more rapid reduction of neck and arm pain (Class III evidence) 3, 4
The addition of a cervical plate is recommended to reduce the risk of pseudarthrosis and graft problems (Class III evidence) 5
Removal of anterior spinal instrumentation is medically necessary when further surgery is approved that requires removal of the instrumentation 2

The patient has undergone appropriate conservative management including physical therapy, spine injections, home therapy, and oral medications 1, 2
Conservative management should be the initial treatment for degenerative cervical disc disease, with 75-90% of patients achieving symptomatic improvement 1
This patient's symptoms have persisted despite these conservative measures, making surgical intervention appropriate 2

For adjacent segment disease at C5-6 following previous ACDF at C6-7, an anterior approach with ACDF is appropriate 3, 5
Anterior cervical discectomy and fusion with instrumentation is recommended to improve arm pain in cervical disc degeneration (Class II evidence) 6
ACDF can achieve good to excellent outcomes in approximately 90% of patients when properly indicated 2

Based on the patient's clinical presentation, imaging findings, and failed conservative management, the proposed removal of plate at C6-7 and ACDF at C5-6 meets medical necessity criteria 2
The procedure addresses the patient's adjacent segment disease at C5-6 with documented neural compression and corresponding radicular symptoms 2
The patient has failed appropriate conservative management including medications, physical therapy, and injections 1, 2