Adjacent Segment Disease

Adjacent Segment Disease

Adjacent segment disease refers to new spinal symptoms above or below the site of previous spinal surgery. This is a real concern for both patients and spine surgeons.

What is segment?

The 33 vertebrae in your spine make up 5 distinct segments. From top to bottom those are:

  • Cervical (neck), which has 7 vertebrae known as C1 to C7
  • Thoracic (middle back), which has 12 vertebrae known as T1 to T12
  • Lumbar (lower back), which has 5 vertebrate known as L1 to L5
  • Sacrum, a triangle-shaped bone that connects to your hips
  • Coccyx (tailbone), four fused vertebrae at the bottom of your spine that connect to your pelvic floor.

What is adjacent segment disease?

If you’re diagnosed with adjacent segment disease, it means you’ve developed new spinal symptoms in an area adjacent to a site of previous spinal surgery.

What causes adjacent segment disease?

Adjacent segment disease can be the result of:

  • The normal progression of a degenerative spinal condition
  • Spinal surgery that has successfully stabilised your spine but resulted in the segments next to the surgery site experiencing greater stress.

Spinal fusion surgery is a type of back surgery that joins together two or more vertebrae to help improve your spine’s stability, correct any deformity, and ease your back pain.

Sometimes though, stiffening certain segments through spinal fusion surgery places additional stress and strain on the adjacent segments of your spine.

Treating a degenerative spinal condition is sometimes a bit like putting out spot fires. Spinal fusion surgery may succeed in relieving the initial symptoms in that area of your spine. But your spine is still degenerating. Limiting movement in one section of your spine can sometimes accelerate degeneration in an adjacent segment. Sometimes this is called ‘failed back surgery’.

How to prevent adjacent segment disease

There’s ongoing research into possible ways to prevent adjacent segment disease.

Adjacent segment disease is thought to happen because limiting movement in one area of the spine leads to greater stress and strain in the neighbouring areas. That suggests that we might need a different type of surgery that stabilises one part of your spine without affecting the adjacent segments.

Motion preservation surgery is a possible way to do that. It’s used as an alternative or addition to spinal fusion surgery and uses dynamic stabilisation devices that allow for controlled spinal motion. Many of those devices are still being researched and are not yet readily available.

So far there is little in the way of clinical evidence that proves that motion preservation prevents adjacent segment disease. However, it may take some time from the introduction of these technologies before the evidence is available.

In the meantime, there is good biomechanical data that suggests that motion preservation is a worthy goal of treatment. 

Adjacent segment disease treatment interventions

Treatment of adjacent segment disease can be a challenge and sometimes involves more surgery.

Non-surgical treatment for adjacent segment disease

Usually, we begin by recommending conservative measures such as physiotherapy or steroid injections in the hope of avoiding the need for revision surgery.

Surgical treatment for adjacent segment disease

If conservative measures don’t provide sufficient relief, we may then recommend revision surgery to treat adjacent segment disease. Such surgery can have many technical difficulties and does involve more risk than primary spine surgery.

If you need extensive revision surgery, it may involve:

  • Decompression of nerves
  • Removal of implants
  • Correction of any spinal deformity
  • Reconstruction with new implants
  • Bone grafting.

Any revision surgery needs to be carefully planned and customised to your unique needs.

How can the Victorian Orthopaedic Spine Service help?

If you have ongoing pain after a previous back surgery, then please contact The Victorian Orthopaedic Spine Service. Dr David Edis will explore your history and, if he diagnoses adjacent segment disease, he can advise you on your treatment options and customise a solution tailored to your needs.

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All information is general in nature. Patients should consider their own personal circumstances and seek a second opinion. Any surgical or invasive procedure carries risks.