Adjacent segment disease: Natural history of lumbar degeneration or consequence of fusion?

Abstract

Adjacent segment disease is a concern following surgical intervention in the lumbar spine. This chapter provides an overview of adjacent segment degeneration and disease and reviews the current literature regarding its etiology. There is considerable debate as to whether adjacent segment disease is a result of natural history of degeneration of the lumbar spine or secondary to changes induced by surgical intervention. Based upon the best available evidence, it is hypothesized that adjacent segment disease is a multifactorial process. Underlying genetic predisposition and environmental factors play an important role. It is also likely that changes in lumbar motion and kinematics following fusion procedures also increase risk of its development. Advances in motion-sparing technologies for the lumbar spine may decrease incidence of adjacent segment disease, but further research is imperative.