An Overview on Management of Adjacent Segment Disease

Abstract

Background: Adjacent segment disease (ASD) is a recognized complication following successful spinal fusion surgery, characterized by the development of new clinical symptoms originating from spinal levels adjacent to the fused segment. These symptoms may include back pain, radiculopathy, myelopathy, or spinal instability and are associated with progressive degenerative changes such as disc degeneration, stenosis, facet hypertrophy, deformity, and loss of sagittal alignment. While many patients can be managed conservatively, a subset develops severe pain, neurological deficits, or functional disability that necessitates surgical intervention. Multiple surgical strategies have been described for the management of ASD, including decompression, extension of fusion, and various interbody fusion techniques; however, outcomes remain variable and the optimal management approach continues to be debated. This review aims to outline the pathophysiology, non-operative treatment options, surgical indications, operative techniques, and potential complications associated with the management of adjacent segment disease following spinal fusion.