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Lumbar Adjacent Segment Disease

What is Adjacent Segment Disease?

Adjacent segment disease is a condition sometimes affecting a disc next to a fused segment (see spinal fusion). The theory is that the motion which has been eliminated at a spinal segment by a fusion, now has to be performed by the disc above and below the fusion. So, these segments have to move more than before the fusion. This could result in more stress placed on these segments and cause degeneration.

Is Adjacent Segment Disease something most Spine Specialists believe exists?

Debate has been going on amongst Spine Specialists for a long time whether this is a true phenomenon. It was thought that perhaps the segments next to a fused segment would degenerate due to the same disease that affected the segment which needed to be fused in the first place.

What is the likelihood that a patient who had a fusion gets Adjacent Segment Disease?

Studies have suggested that the chance of a disc next to a fusion will require surgery to be about 3% per year after the fusion. By 10 years, 25% of these patients would need surgery at a disc next to a fusion.

Debate still continues on this subject, however.

How is Adjacent Segment Disease treated?

Most cases of Adjacent Segment Disease may not need treatment other than conservative, non-surgical spine care.

However, patient with severe pain who have not responded to conservative care or those who have significant neurological problems can be treated with the following options:

  1. A discogram is often performed first to make sure the disc adjacent to the fusion is in fact the source of the pain.
  2. The fusion can be extended to the diseased disc.
  3. Sometimes an Artificial Disc Replacement is an option next to a fusion to maintain some movement at this spinal level. This may be somewhat controversial as Artificial Disc Replacement were not specifically designed for this situation.