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Adjacent Segment Disease After Spinal Fusion.
Christopher L McDonald1,2, Daniel Alsoof1, Jacob Glueck2
1Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
JBJS Reviews
|June 12, 2023
Summary
Adjacent segment disease involves spine degeneration near fused areas, causing symptoms like pain and instability. Treatment is typically nonoperative, but surgery may be needed for severe cases.
Area of Science:
- Spine surgery
- Degenerative spine conditions
Background:
- Adjacent segment disease (ASD) is a degenerative process occurring next to a previously fused spinal segment.
- ASD can manifest with new clinical symptoms including radiculopathy, myelopathy, or instability.
- Etiology is multifactorial, involving disease natural history, biomechanical stress, patient-specific factors, surgical techniques, and spinal alignment.
Purpose of the Study:
- To review the characteristics, etiology, and treatment of adjacent segment disease.
- To highlight the current understanding and future research directions for ASD management.
Main Methods:
- Literature review and synthesis of current knowledge on adjacent segment disease.
- Analysis of etiological factors and treatment options, including nonoperative and surgical interventions.
Main Results:
- Nonoperative management is the primary treatment approach for adjacent segment disease.
- Surgical intervention, primarily decompression and fusion, is indicated for specific cases.
- Isolated decompression may be considered in select situations.
Conclusions:
- Further randomized controlled trials are necessary to guide treatment progression for adjacent segment disease.
- The development of minimally invasive and endoscopic surgical techniques warrants further investigation in ASD management.
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