Adjacent Segment Disease: A Complication?

One of the most enduring controversies of spine surgery has been the question of propagation of disc degeneration beyond a single disc level into other adjacent motion segments. Undoubtedly there is a strong, inherent propensity of some patients to develop disc degeneration in more than one level. What is the role of surgical intervention in potentially propagating this process to other levels -- be it through decompression surgery, fusion or arthroplasty surgery?
These are important considerations not only for patients and their health care providers, but also for insurers and health care rating agencies as reoperations in spine surgery have become an important evaluation point. Dr. Lee from the University of Washington and Visiting Professor Dr. McGuire from the University of Mississippi provide their respective views on this topic.
Robert A. McGuire, MD, Michael J. Lee, MD
9/30/2011

[@jrchicago9216]

Adjacent Segment Disease (ASD) is a BIG deal. 6 to 12 years after a fusion, then the next level is burned out. I see fusions as necessary in only cases where the patient is not a good candidate for artificial implants. I traveled to Barcelona Spine Center in 2016 and had the Spinal Kinetics M6L lumbar implant and paid $26k and returned in 2018 for a double level cervical ESP discs and paid $35k. VERY happy. The main difference is a cushion effect. The US implants are hard so may not work as well.

[@TheCgates9119]

How's it going now? I'm being told that I need a multi level fusion. I'm trying to find another solution. The US Doctors say I'm not a candidate but I would like to check with the doctors whi did your surgery.

[@supernova44]

Had an open TLIF on L4-5 and L5-S1 years ago that was technically successful but I developed epidural fibrosis of the nerve roots. I also have multi level spinal arthritis, facet hypertrophy, DDD, and stenosis. Im guessing I am genetically susceptible to rapid degenerative changes in my spine. Also suffering from OA and RA. This was very informative and i wish i had been more aware of surgical complications back then.

[@imveryhungry112]

You need an updated spinal fusion 😊

[@Anonymous-xy7mh]

As a failed spinal fusion patient, don't undergo a knife! These surgeons don't offer us no cure.

[@imveryhungry112]

You should get a newer spinal fusion 😊

[@jrchicago9216]

ASD is a complication. Europe is not seeing ASD returns after 14 years with the Spinal Kinetics M6. Because it restores motion and has a cushion effect design, the energy transfer is dampened. Many disc implants are hard, a big problem.

[@DrHenryDimaano]

For starters, "funding generously provided by Synthes" kind of tells you a lot from the get-go. So I think slamming the SAS group for being biased is quite disingenuous. Anyway, once upon a time (i.e., about a decade ago), diehard advocates of open fusion techniques argued that obliterating the spine's motion wouldn't cause adjacent segment disease - because "natural history" of course - albeit, fusion might speed up this "natural history" (see 10:20) 😂... They also argued that MIS (tubular) technique wasn't really all that great as far as surgical complication, cost-effectiveness, patient satisfaction, etc... were concerned. Funny how MIS vindicated itself and became the working standard anyways. (And now, the shoe is on the other foot -- with some MIS advocates now saying what was said of them a decade ago to describe the latest endoscopic spine surgery techniques.) 😊 Times change, technologies change, but human nature stays the same.

[@abraxas511]

I dont believe its genetic. I never had any neck or back problems until a herniated c7-t1 that I had fusion on in 2006. Thirteen years later the t1-t2 is now gone and requires surgery. If not for that first fussion that second injury would never have happened. My spine is not degenerating anywhere else. I had a fusion, now I have ASD.

[@V838monocerotis27]

Does everyone get this ASD?

[@abraxas511]

@@V838monocerotis27 I dont think so. You can read studies on it. Its a risk factor everyone has to weigh and each person is different. Do your research and ask your surgeon a lot of questions.

[@imveryhungry112]

You just need an updated fusion 😊