Adjacent segment disease and degeneration after lumbar spine surgery

Abstract

Lumbar spine fusion surgeries have adverse effects on adjacent segments and lead to adjacent segment disease and degeneration which increase the possibility of revision surgery and affect the final outcome. If new degeneration or aggravation of the primary degeneration in the adjacent segment only occurs in the images but without corresponding clinical symptoms, it would be called adjacent segment degeneration; if the corresponding clinical symptoms co-exist with degeneration in images, it would be called adjacent segment disease. Generally, the stress concentration on adjacent intervertebral discs and facet joints caused by spine fusion is the main pathogeny of adjacent segment degeneration and disease. The damage of normal spinal anatomy structure in surgery and the natural spine degeneration process are also important pathogenic factors. The occurrence of adjacent segment degeneration and disease after lumbar surgery is related to age, body weight, postoperative spinal-pelvic sagittal balance and the preoperative degeneration of adjacent segment. Surgical programs including numbers of the fusion segments, surgical approach and whether to adopt non-fusion technology have great effect on the occurrence of adjacent segment degeneration and disease. In the planning of surgeries, necessary measures and methods should be taken to prevent adjacent segment disease and degeneration according to the different patients. Non-fusion technology, minimally invasive spine surgery technique and Topping-off technique can help reduce the occurrence of adjacent segment disease and degenerative. If the patients are combined with high risk factors of adjacent segment degeneration and disease, more attention should be paid and appropriate and individualized therapies should be chosen.