What Is Adjacent Segment Disease?

Adjacent segment disease refers to the breakdown of spinal segments located directly above or below a previous spinal fusion. When surgeons fuse vertebrae together, the surrounding segments must work harder to maintain normal spine movement. This increased stress can lead to faster wear and tear of the discs, joints, and ligaments in these areas.

The condition typically develops months or years after your initial spine surgery. While not everyone who has spinal fusion will develop ASD, studies show it affects approximately 10-20% of patients within 10 years of their original procedure.

Understanding Adjacent Segment Disease in the Lumbar Spine

Lumbar adjacent segment disease is particularly common because the lower back carries much of your body’s weight during daily activities. The lumbar spine naturally experiences significant stress, and when fusion limits motion in one area, the adjacent levels must compensate.

Adjacent segment disease lumbar spine symptoms often include:

• New or worsening back pain
• Leg pain or numbness
• Radiating leg pain or sciatica
• Difficulty walking or standing for long periods
• Stiffness in the lower back
• Reduced flexibility and range of motion

These symptoms develop because the discs and joints above or below your fusion site begin to degenerate more rapidly than they would under normal circumstances.

What Causes Adjacent Segment Disease?

Several factors contribute to the development of spinal fusion adjacent segment disease:

Increased Mechanical Stress

When vertebrae are fused together, they can no longer move independently. The segments above and below your fusion must work harder to maintain normal spine flexibility, leading to accelerated wear.

Natural Aging Process

The natural aging of your spine continues after fusion surgery. The increased stress on adjacent segments can speed up this degenerative process.

Surgical Factors

The type of fusion procedure, number of levels fused, and surgical approach can influence your risk of developing ASD. Longer fusion constructs typically place more stress on adjacent segments.

Pre-existing Conditions

If you had some degeneration in adjacent segments before your original surgery, you may be at higher risk for developing adjacent segment disease.

Adjacent Segment Disease with Spinal Stenosis

Adjacent segment stenosis occurs when the spinal canal narrows at levels next to your fusion. This combination can create particularly challenging symptoms, including:

• Severe leg pain that worsens with walking
• Numbness or tingling in your legs
• Weakness in your lower extremities
• Difficulty with balance and coordination

The stenosis develops as the adjacent segments work harder to maintain movement, leading to thickening of ligaments and bone spurs that narrow the spinal canal.

Treatment for Adjacent Segment Disease

Adjacent segment disease treatment depends on the severity of your symptoms and the extent of degeneration. Your neurosurgeon will typically recommend starting with conservative approaches before considering surgical options.

Conservative Treatment Options

Physical Therapy

Targeted exercises can help strengthen the muscles supporting your spine and improve flexibility. A physical therapist can teach you proper body mechanics to reduce stress on adjacent segments.

Pain Management

Anti-inflammatory medications, muscle relaxants, and nerve blocks can help manage pain and inflammation. Your doctor may recommend epidural injections to provide targeted relief.

Activity Modification

Adjusting your daily activities and avoiding movements that worsen your symptoms can help prevent further degeneration.

Bracing

In some cases, a back brace may provide additional support and reduce stress on adjacent segments.

Adjacent Segment Disease Surgery

When conservative treatments fail to provide adequate relief, adjacent segment disease surgery may be necessary. Surgical options include:

Extension of Fusion

This involves extending your original fusion to include the affected adjacent segments. While effective for pain relief, it further reduces spinal mobility.

Disc Replacement

In some cases, artificial disc replacement may be an option to maintain motion while addressing the degenerative changes.

Decompression Surgery

For adjacent segment stenosis, decompression procedures can relieve pressure on nerves without requiring fusion.

Adjacent Segment Disease Treatment Interventions

Modern treatment interventions for adjacent segment disease focus on personalized care tailored to your specific condition and needs. Your treatment plan may include:

Minimally Invasive Approaches

Many procedures can now be performed using minimally invasive techniques, which offer benefits such as:

• Smaller incisions
• Less tissue disruption
• Faster recovery times
• Reduced risk of complications

Motion-Preserving Technologies

Newer surgical techniques aim to preserve motion while addressing the underlying problem. These may include dynamic stabilization systems or artificial disc replacement.

Comprehensive Rehabilitation

Post-treatment rehabilitation programs help you regain strength, flexibility, and function while preventing future complications.

Prevention and Long-term Management

While you cannot completely prevent adjacent segment disease, certain strategies can reduce your risk:

• Maintain a healthy weight to reduce stress on your spine
• Stay physically active with low-impact exercises
• Practice good posture and body mechanics
• Attend regular follow-up appointments with your spine specialist
• Address new symptoms promptly rather than waiting for them to worsen

When to Seek Treatment

Contact your spine specialist if you experience:

• New or worsening back pain months or years after fusion surgery
• Leg pain, numbness, or weakness
• Difficulty walking or performing daily activities
• Stiffness that doesn’t improve with rest

Early intervention can often prevent the condition from progressing and may allow for less invasive treatment options.

Finding the Right Care

Adjacent segment disease requires specialized expertise for proper diagnosis and treatment. Look for a neurosurgeon who has experience with revision spine surgery and can offer both conservative and surgical treatment options.

Your spine specialist should thoroughly evaluate your condition using advanced imaging and work with you to develop a personalized treatment plan that addresses your specific symptoms and goals.

Don’t let adjacent segment disease limit your quality of life. With proper treatment and management, many patients experience significant improvement in their symptoms and can return to their normal activities.

If you’re experiencing symptoms that may indicate adjacent segment disease, don’t wait to seek expert care. Contact our experienced spine specialists today at 551-284-3265 to schedule a consultation and explore your treatment options.

Frequently Asked Questions

How long after spinal fusion does adjacent segment disease typically develop?

Adjacent segment disease can develop anywhere from several months to many years after your original fusion surgery. Most cases occur within 5-10 years of the initial procedure, though some patients may develop symptoms sooner or later depending on individual factors like age, activity level, and the extent of their original fusion.

Can adjacent segment disease be prevented completely?

While there’s no guaranteed way to prevent adjacent segment disease, you can reduce your risk by maintaining a healthy weight, staying physically active, practicing good posture, and following your surgeon’s post-operative instructions. Some newer surgical techniques that preserve motion may also help reduce the risk, though research is ongoing.

Is revision surgery always necessary for adjacent segment disease?

No, revision surgery is not always required. Many patients find relief through conservative treatments such as physical therapy, medications, injections, and lifestyle modifications. Surgery is typically considered only when conservative treatments fail to provide adequate pain relief or when neurological symptoms worsen.

What’s the difference between adjacent segment disease and normal aging of the spine?

Adjacent segment disease involves accelerated degeneration specifically at the levels next to a previous fusion, occurring faster than normal aging would cause. While everyone’s spine naturally degenerates over time, ASD represents abnormally rapid deterioration due to increased mechanical stress from the fusion.

How successful is treatment for adjacent segment disease?

Treatment success varies depending on the severity of your condition and the type of treatment used. Conservative treatments help many patients manage their symptoms effectively. For those requiring surgery, success rates are generally good, though recovery may take longer than your original fusion surgery due to the complexity of revision procedures.

Authors of this Blog: The Livingston Spine Team