In Reply: Congenitally Fused Cervical Spine is Associated With Adjacent-Level Degeneration in the Absence of Cervical Spine Surgery

To the Editor: We thank Dr Goel for his letter regarding our article1,2 detailing adjacent segment degeneration in the cervical spine in patients with congenital cervical fusion. It is certainly intriguing to consider the hypothesis that spinal segmental fusion is always secondary. However, the preponderance of literature on this topic has considered the type of fusion that we described as a congenital error of segmentation.3-6 The vast proportion of patients in our cohort were identified asymptomatically and did not require nor receive any treatment for the incidental segmental fusion that was observed. This leads us to believe that the segmental fusion observed in our study was not associated with clinically significant spinal instability.