Journal Article

Do all symptomatic adjacent segment diseases (ASD) require surgery? a prognostic classification and predictors of surgical treatment of lumbar ASD

Shetty, Ajoy Prasad, Kanna, Rishi M, Prakash, Gnana, Shanmuganathan, Rajasekaran

2025

Overview

Introduction Symptomatic Adjacent segment disease presents in myriad ways with varying clinic-radiological presentation but the optimal management and the factors that predict need for revision surgery are unclear. Methodology Consecutive patients ( n  = 132) who experienced significant back or leg pain after an asymptomatic period (minimum 1 year) following a lumbar fusion were evaluated with dynamic radiographs and MRI. ASD was classified anatomically as proximal (86.3%), distal (12.1%, or combined (1.5%) and, sub-classified pathologically into six sub-types: Type 1: Disc prolapse (17.4%), Type 2: Disc degeneration with intra-discal instability (15.1%), Type 3: Anterolisthesis and facet instability (6.8%), Type 4: Retrolisthesis (25%), Type 5: Stenosis (21.9%) and Type 6: Combined types (13.6%). Results The mean duration between the index surgery and ASD was 5.9 ± 4.1 years. Surgery was required in 40.9% (54/132). Six factors were highly predictive of surgical treatment for ASD, viz., Diabetes mellitus (OR-4.3, p  = 0.007), ASD– disc prolapse (OR 6.3, p  = 0.018), ASD intra-discal instability (OR-16.8206, p  = 0.003), ASD - anterolisthesis (OR − 8.2998, p  = 0.043), Facet angle > 75° (OR 37.6, p  = 0.02) and radiculopathy (OR 48.0, p  = 0.002). Retrolisthesis was the most benign type as 84.8% patients were managed conservatively ( p  = 0.016). Among proximal ASD, retrolisthesis was the most common subtype (28.9%) while disc prolapse was the most common subtype in distal ASD 37.5% ( p  = 0.032). Conclusion The study classifies the versatile clinic-radiological presentation of ASD, and identifies factors that predicted the development of the different sub-types of ASD. Knowledge about the six clinic-radiological factors that predict the need for surgical treatment in ASD is beneficial.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Adult / Aged / Diabetes mellitus / Female / Humans / Instability / Intervertebral Disc Degeneration - diagnostic imaging / Intervertebral Disc Degeneration - surgery / Intervertebral Disc Displacement - diagnostic imaging / Intervertebral Disc Displacement - surgery / Intervertebral discs / Lumbar Vertebrae - diagnostic imaging / Lumbar Vertebrae - pathology / Lumbar Vertebrae - surgery / Magnetic Resonance Imaging / Male / Medicine / Medicine & Public Health / Middle Aged / Neurosurgery / Patients / Prognosis / Reoperation / Spinal Fusion - adverse effects / Spinal Stenosis - surgery / Stenosis / Surgery / Surgical Orthopedics