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How to Treat Adjacent-Segment Pathology Following Lumbar Fusion Surgery: Decompression Alone or Decompression With
Mohamed Elmekaty1,2, Anders Joelson3,4, Peter Försth3,5
1Department of Surgical Sciences, Orthopedics and Hand Surgery, Uppsala University, Uppsala, Sweden. mohamed.elmekaty@uu.se.
Neurospine
|August 7, 2026
Summary
Extending fusion for adjacent segment pathology after lumbar fusion surgery increased the risk of needing more surgery. Careful consideration is needed due to potential confounding factors.
Area of Science:
- Spine surgery
- Adjacent segment pathology
- Lumbar fusion
Background:
- Clinical adjacent-segment pathology (CASP) can occur after lumbar fusion.
- Treatment options for CASP include decompression alone or with extended fusion.
Purpose of the Study:
- To compare the risk of subsequent surgery after CASP treatment.
- Evaluate decompression alone versus decompression with extended fusion.
Main Methods:
- Retrospective analysis of 2,521 patients from the Swespine registry (1997-2019).
- Comparison of subsequent surgeries using Kaplan-Meier analysis and Cox regressions.
- Adjusted for confounders like age, BMI, smoking, and surgical details.
Main Results:
- Extended fusion group had a 5-year subsequent surgery probability of 25% vs. 18% for decompression alone.
- Extended fusion was associated with a 1.26 hazard ratio for subsequent surgery (p=0.032).
- Mean follow-up was 6.1 years; median time to re-operation was 1.7 years.
Conclusions:
- Extending fusion for CASP may increase the risk of subsequent surgery.
- Causality requires cautious interpretation due to limitations in radiographic data verification.