Adjacent segment degeneration after fusion spinal surgery—a systematic review
- 341 Downloads
Adjacent segment degeneration (ASDeg) and disease (ASDis) have become major concerns after fusion surgery. However, there is no definitive data or knowledge about the incidence or risk factors. The review discusses the incidence and risk factors and prevention of ASDeg and ASDis in the relevant literature.
We performed a systematic review of meta-analyses, randomized control trials, and cohort studies published in English to provide evidence-based information about ASDeg and ASDis.
According to a meta-analysis, the pooled incidence of ASDeg after lumbar and cervical fusion surgery was 26.6% and 32.8%, respectively. Approximately 1/4–1/3 of ASDeg progressed to ASDis. Risk factors after cervical fusion surgery were young age, pre-existing disc degeneration, short fusion segment, high T1 slope, disruption of adjacent soft tissue, and plate placement close to the adjacent disc. The risk factors of ASDeg and ASDis after lumbar fusion surgery were age, genetic factors, high body mass index, pre-existing adjacent segment degeneration, laminectomy at the adjacent level of fusion, excessive distraction of the fusion level, insufficient lumbar lordosis, multilevel fixation, floating fusion, coronal wedging of L5-S disc, pelvic tilt, and osteoporosis. Motion-preserving surgeries seem to have less risk of ASDeg and ASDis than conventional fusion surgery both in the lumbar and cervical spine.
The existent literature points out variables involved in ASDeg and ASDis. High evidence-level studies should provide more relevant data to guide strategies for avoiding ASDeg and ASDis.
KeywordsAdjacent segment degeneration Adjacent segment disease Fusion surgery Lumbar spine Cervical spine
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 5.Saavedra-Pozo FM, Deusdara RA, Benzel EC (2014) Adjacent segment disease perspective and review of the literature. Ochsner J 14(1):78–83Google Scholar
- 11.Boos N, Rieder R, Schade V, Spratt KF, Semmer N, Aebi M (1995) 1995 Volvo award in clinical sciences. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine (Phila Pa 1976) 20(24):2613–2625CrossRefGoogle Scholar
- 12.Borenstein DG, O’Mara JW Jr, Boden SD, Lauerman WC, Jacobson A, Platenberg C, Schellinger D, Wiesel SW (2001) The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study. J Bone Joint Surg Am 83-A(9):1306–1311CrossRefGoogle Scholar
- 17.Bydon M, Xu R, Santiago-Dieppa D, Macki M, Sciubba DM, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF (2014) Adjacent-segment disease in 511 cases of posterolateral instrumented lumbar arthrodesis: floating fusion versus distal construct including the sacrum. J Neurosurg Spine 20(4):380–386CrossRefGoogle Scholar
- 26.Miyagi M, Ikeda O, Ohtori S, Tsuneizumi Y, Someya Y, Shibayama M, Ogawa Y, Inoue G, Orita S, Eguchi Y, Kamoda H, Arai G, Ishikawa T, Aoki Y, Toyone T, Ooi T, Takahashi K (2013) Additional decompression at adjacent segments leads to adjacent segment degeneration after PLIF. Eur Spine J 22(8):1877–1883CrossRefGoogle Scholar
- 38.Maiman DJ, Kumaresan S, Yoganandan N, Pintar FA (1999) Biomechanical effect of anterior cervical spine fusion on adjacent segments. Biomed Mater Eng 9(1):27–38Google Scholar
- 40.Matsumoto M, Okada E, Ichihara D, Watanabe K, Chiba K, Toyama Y, Fujiwara H, Momoshima S, Nishiwaki Y, Iwanami A, Ikegami T, Takahata T, Hashimoto T (2010) Anterior cervical decompression and fusion accelerates adjacent segment degeneration: comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study. Spine (Phila Pa 1976) 35(1):36–43CrossRefGoogle Scholar
- 48.Imagama S, Kawakami N, Matsubara Y, Tsuji T, Ohara T, Katayama Y, Ishiguro N, Kanemura T (2016) Radiographic adjacent segment degeneration at 5 years after L4/5 posterior lumbar interbody fusion with pedicle screw instrumentation: evaluation by computed tomography and annual screening with magnetic resonance imaging. Clin Spine Surg 29(9):E442–E451CrossRefGoogle Scholar
- 52.Basques BA, Louie PK, Mormol J, Khan JM, Movassaghi K, Paul JC, Varthi A, Goldberg EJ, An HS (2018) Multi- versus single-level anterior cervical discectomy and fusion: comparing sagittal alignment, early adjacent segment degeneration, and clinical outcomes. Eur Spine J 27(11):2745–2753Google Scholar