• Jun Young Yang, June-Kyu Lee, and Ho-Sup Song.
• Department of Orthopedic Surgery, School of Medicine, Chungnam National University, Daejeon, Korea. jyyang@cnu.ac.kr
• Spine. 2008 Mar 1; 33 (5): 503-7.

Study DesignA retrospective study.ObjectiveTo determine the impact of the adjacent segment degeneration (ASD) on the clinical outcome after lumbar fusion.Summary Of Background DataFew studies have analyzed correlation between clinical outcomes and ASD.MethodsFrom January 2000 to December 2004, 217 patients who underwent lumbar fusion and have more than 2 years of follow-up were evaluated. The patients were divided into 3 groups: fusion was carried out on 1 (A), 2 (B), and more than 3 segments (C). UCLA grading scale was used to evaluate the ASD on radiograph preoperative, postoperative, and last follow-up. The clinical outcome was evaluated and the association between clinical outcome and ASD was evaluated by the Spearman correlation.ResultsASD occurred 11.6% (13/112 cases) in group A, 14.5% (9/62 cases) in group B, and 16.3% (7/43 cases) in group C. Among them, the cases which had progressed more than 2 level of degenerative grade were 0 in group A, 7 cases (77.8%) in group B, and 6 cases (85.7%) in group C. In group A, 5 cases with ASD had down graded 1 level in clinical outcome. In group B, all 9 cases with ASD had down graded more than 1 level in clinical outcome; 1 level aggravation in 1, 2 level in 5, and 3 level in 1 case. In group C, all 7 cases with ASD also had down graded more than 1 level in clinical outcome; 1 level aggravation in 2, 2 level in 5 cases. Finally, the more the change of the degenerative grade is severe, the more the clinical outcome is worse (P < 0.05).ConclusionThe impact of ASD on clinical outcome after fusion showed a significant correlation, especially with the ASD after multiple-segments fusion. Careful attention is needed in multiple-segments fusion such as degenerative lumbar deformity.

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