title: Adjacent segment disease in the lumbar spine following different treatment interventions.
abstract: BACKGROUND
  Adjacent segment disease (ASD) is symptomatic deterioration of spinal levels adjacent to the site of a previous fusion. A critical issue related to ASD is whether deterioration of spinal segments adjacent to a fusion is due to the spinal intervention or due to the natural history of spinal degenerative disease.
  
  
  OBJECTIVE
  The purpose of this review is to summarize the recent clinical literature on adjacent segment disease in light of the natural history, patient-modifiable risk factors, surgical risk factors, sagittal balance, and new technology.
  
  
  METHODS
  This review will evaluate the recent literature on genetic and hereditary components of spinal degenerative disease and potential links to the development of ASD.
  
  
  METHODS
  After a meticulous search of Medline for relevant articles pertaining to our review, we summarized the recent literature on the rate of ASD and the effect of various interventions, including motion preservation, sagittal imbalance, arthroplasty, and minimally invasive surgery.
  
  
  RESULTS
  The reported rate of ASD after decompression and stabilization procedures is approximately 2% to 3% per year. The factors that are consistently associated with adjacent segment disease include laminectomy adjacent to a fusion and a sagittal imbalance.
  
  
  CONCLUSIONS
  Spinal surgical interventions have been associated with ASD. However, whether such interventions may lead to an acceleration of the natural history of the disease remains questionable.
authors.affiliation: Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA. Electronic address: radcliffk@gmail.com.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Radcliff
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.forename: Andre
authors.initials: A
authors.lastname: Jakoi
authors.forename: Gursukhman S
authors.initials: GS
authors.lastname: Sidhu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rihn
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
authors.forename: Alan S
authors.initials: AS
authors.lastname: Hilibrand
mesh_terms: D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000235:genetics / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods*
keywords: Adjacent segment degeneration; Decompression; Fusion; Lumbar