• Georgios A Maragkos, Rouzbeh Motiei-Langroudi, Aristotelis S Filippidis, Paul A Glazer, and Efstathios Papavassiliou.
• Neurosurgical Service, Boston, Massachusetts, USA.
• World Neurosurg. 2020 Jan 1; 133: e690-e694.

ObjectiveAdjacent segment disease (ASD) is a long-term complication of lumbar spinal fusion. This study aims to evaluate demographic and operative factors that influence development of ASD after fusion for lumbar degenerative pathologies.MethodsA retrospective cohort study was performed on patients undergoing instrumented lumbar fusion for degenerative disorders (spondylolisthesis, stenosis, or intervertebral disk degeneration) with a minimum follow-up of 6 months.ResultsOur inclusion criteria were met by 568 patients; 29.4% of patients had developed surgical ASD. Median follow-up was 2.8 years. Multivariate logistic regression analysis showed that decompression of segments outside the fusion construct had higher ASD (odds ratio = 2.6; P < 0.001), and those undergoing fusion for spondylolisthesis had lower ASD (odds ratio = 0.47; P = 0.003).ConclusionsResults of our study show that the most important surgical factor contributing to ASD is decompression beyond fused levels. Hence caution should be exercised when decompressing spinal segments outside the fusion construct. Conversely, spondylolisthesis patients had the lowest ASD rates in our cohort.Copyright © 2019 Elsevier Inc. All rights reserved.

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