Does lumbar fusion increase the risk of disc degeneration of the adjacent segment?

✍ Scribed by Erica Flanagan; Neal Wiggermann; Ash Genaidy; Jeffery Stambough; Richard Shell

• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 323 KB
• Volume: 18
• Category: Article
• ISSN: 1090-8471
• DOI: 10.1002/hfm.20107

✦ Synopsis

Abstract

Several reviews have attempted to establish whether there is an association between adjacent segment disorder and spinal fusion. None of these studies used an evidence‐based approach or solely focused on studies utilizing controls. The goal of this article is to identify any significant link between lumbar or lumbosacral spinal fusion and development of adjacent segment disease using literature with more than a 10‐year follow‐up, at least 15 subjects, and a control with no exposure to fusion. The published articles were obtained from a search of electronic databases and bibliographies of identified articles. The critical appraisal was performed using an epidemiological appraisal instrument. Five articles satisfied the inclusion criteria. From the literature, no definitive conclusion could be drawn regarding adjacent segment disorder as an outcome of spinal fusion. The failure of the literature to link adjacent segment disease to spinal fusion at least suggests the problem may not be widespread, but also fails to disprove the myriad of biomechanical concerns. Device manufacturers should address these concerns by furthering the development of motion preservation instrumentation and other innovations. Helping to drive this technology will be a larger data set of research with sound methodological quality and inclusion of accepted radiographic and functional outcomes. The reported findings underscore a need for information on spinal fusion and require a strategy for moving forward. © 2008 Wiley Periodicals, Inc.