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Revision Spine Surgery
Adjacent Segment Disease Surgery
An in-depth, evidence-based explanation of surgery for adjacent segment disease — when the level next to a previous fusion wears out and becomes symptomatic, and how it can be treated.
When a segment of the spine is fused, the levels immediately above or below take on extra mechanical load. Over the years, this can contribute to that adjacent level wearing out and, in some people, becoming symptomatic — a condition known as adjacent segment disease. It can cause new nerve compression, with leg or arm symptoms, or new instability and pain. Many cases are managed without surgery, but where symptoms are significant and clearly arising from the adjacent level, surgery can help. This page explains what adjacent segment disease is and how it can be treated.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
What adjacent segment disease is
It helps to distinguish two things. Adjacent segment degeneration is wear seen on imaging at the level next to a fusion, which is common and often causes no symptoms. Adjacent segment disease is when that level becomes genuinely symptomatic — for example compressing a nerve and causing leg or arm pain, or becoming unstable and painful. Only the symptomatic form needs treatment. It occurs after both lumbar and cervical fusions, and part of the assessment is confirming that the new symptoms really are coming from the adjacent level rather than elsewhere.
How it can be treated
When surgery is needed, the treatment is directed at the affected adjacent level. Where the problem is nerve compression, the level is decompressed. Where there is instability, or where decompression alone would leave the segment unstable, the fusion is usually extended to include the adjacent level, joining it to the existing construct. In selected cases, a focal decompression — sometimes achievable through a minimally invasive or endoscopic approach — may relieve nerve compression while preserving the segment. The choice depends on the exact problem and on how much instability is present.
Weighing up extension of a fusion
Extending a fusion solves the immediate problem but lengthens the fused segment, which in turn places load on the next level along. This is an important consideration, and it is weighed carefully: the aim is to relieve the current symptoms durably while being thoughtful about the longer-term mechanics of the spine. For some people a limited decompression is enough; for others, extending the fusion is the more reliable answer. The decision is individualised to the pattern of disease and the person's overall spinal alignment.
What the evidence shows
The evidence characterises adjacent segment disease and guides its treatment. Systematic reviews and meta-analyses describe its incidence after lumbar and cervical fusion and distinguish degeneration from symptomatic disease. Studies identify risk factors and report the outcomes of surgery — including decompression and extension of fusion — for symptomatic adjacent segment disease, and compare approaches in the cervical spine. This literature supports treating the symptomatic level directly while thinking carefully about the mechanics of the whole spine.
What to expect
Whether surgery is needed for adjacent segment disease, and which operation is best, depends on the symptoms, the imaging, the degree of instability and the overall alignment of the spine. Where surgery is appropriate, it is directed at the affected level, sometimes with a minimally invasive decompression and sometimes with an extension of the existing fusion. The options, realistic expectations and risks are discussed individually.
Disclaimer. The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Every patient is different, and treatment options, risks, expected recovery and outcomes depend upon an individual's diagnosis, previous surgery, general health and personal circumstances. Decisions regarding treatment should always be made following consultation with your treating spinal surgeon or healthcare professional.
Evidence & further reading
- —Xia XP, et al. Adjacent segment degeneration versus disease after lumbar fusion: systematic review with meta-analysis. Clin Spine Surg 2016. (PMID 26836484)
- —Lawrence BD, et al. Predicting the risk of adjacent segment pathology after lumbar fusion: a systematic review. Spine 2012. (PMID 22885827)
- —Wang H, et al. Prevalence of adjacent segment disease after cervical spine surgery: systematic review and meta-analysis. 2016. (PMID 27399140)
- —Nemani VM, et al. Adjacent segment disease after ACDF: anterior versus posterior repeat cervical fusion. Spine 2014. (PMID 24843815)
- —Chan AK, et al. Lumbar adjacent segment degeneration after spinal fusion: systematic review and meta-analysis. 2023. (PMID 36345970)
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