Update on the evidence for adjacent segment degeneration and disease

Spine J. 2013 Mar;13(3):342-51. doi: 10.1016/j.spinee.2012.12.009. Epub 2013 Feb 15.


Background context: The evidence surrounding the topic of adjacent segment degeneration and disease has increased dramatically with an abundant amount of literature discussing the incidence of and techniques to avoid it. However, this evidence is often confusing to discern because of various definitions of both adjacent segment degeneration and disease.

Purpose: To organize and review the recent evidence for adjacent segment degeneration and disease.

Results: Although multifactorial, three distinct causes of adjacent segment disease in both the lumbar and cervical spine have been discussed: the natural history of the adjacent disc; biomechanical stress on the adjacent level caused by the fusion; and disruption of the anatomy at the adjacent level with the initial surgery. The incidence of adjacent segment degeneration in the lumbar spine has been widely reported in the literature from 0% to 100%; conversely, the reported incidence in the cervical spine is less variable. Similarly, strategies at avoiding adjacent segment disease in the lumbar spine include arthroplasty, dynamic fixation, and percutaneous fixation, whereas in the cervical spine the focus has remained on arthroplasty.

Conclusions: Adjacent segment disease and degeneration remain a multifactorial problem with several techniques being developed recently to minimize them. In the future, it is likely that the popularity of these techniques will be dependent on the long-term results, which are currently unavailable.

Publication types

  • Review

MeSH terms

  • Biomechanical Phenomena
  • Cervical Vertebrae / pathology
  • Cervical Vertebrae / surgery
  • Humans
  • Intervertebral Disc / pathology*
  • Intervertebral Disc / surgery
  • Intervertebral Disc Degeneration / diagnosis*
  • Intervertebral Disc Degeneration / pathology
  • Intervertebral Disc Degeneration / surgery
  • Lumbar Vertebrae / pathology
  • Lumbar Vertebrae / surgery
  • Spinal Fusion
  • Stress, Mechanical
  • Total Disc Replacement