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Post-Fusion Spinal Condition

Adjacent Segment Disease

Adjacent segment disease is a recognized long-term complication of spinal fusion in which accelerated degeneration occurs at the vertebral levels immediately above or below a prior fusion. It can cause new pain, nerve compression, or spinal cord symptoms — and often requires evaluation by an experienced revision spine surgeon.

Overview

Understanding Adjacent Segment Disease

Spinal fusion eliminates motion at the treated level, which is the intended goal. However, the segments immediately above and below the fusion must now accommodate movement that was previously distributed across multiple levels. This increased mechanical load can accelerate degenerative changes at these "adjacent segments" — a process known as adjacent segment disease (ASD) or adjacent level disease.

ASD can develop in both the cervical (neck) and lumbar (lower back) spine and can produce disc herniations, facet joint arthritis, spinal stenosis, or instability at the neighboring levels. Symptoms are often similar to the original condition but appear at a new location — typically months to years after the primary surgery.

Common Symptoms
  • New neck or back pain after prior spinal fusion
  • Arm or leg pain radiating from a different level than the original surgery
  • Numbness or tingling in a new distribution
  • Progressive weakness in the arms or legs
  • In cervical ASD: hand clumsiness or balance problems (myelopathy)
  • Symptoms that initially improve after surgery, then recur at a different location
Risk Factors
  • Greater number of levels fused
  • Pre-existing degeneration at adjacent levels
  • Older age at time of fusion
  • Fusion extending to the sacrum (lumbar spine)
  • High physical activity or demanding occupation
  • Obesity
  • Smoking (impairs disc and bone health)
Diagnosis

Identifying the Source

Evaluating a patient with symptoms after prior spinal surgery requires careful correlation of clinical findings with imaging. Not all post-fusion symptoms are due to adjacent segment disease — other causes such as pseudarthrosis (failed fusion), hardware issues, or progression of disease at a different level must also be considered.

Typical Diagnostic Workup
MRI of the affected spine region is the primary study, revealing disc herniations, stenosis, or cord compression at adjacent levels. CT scan provides detail on bone quality, fusion status, and hardware integrity. Flexion-extension X-rays assess spinal stability. In some cases, diagnostic nerve root or facet injections help confirm the pain generator before surgical planning.

Accurate diagnosis is essential because the surgical approach — if indicated — depends entirely on whether the problem is a new disc herniation, stenosis without instability, instability requiring extension of fusion, or a combination. An experienced revision spine surgeon is best positioned to interpret these findings in the context of the prior surgical anatomy.

Treatment

Conservative and Surgical Options

Treatment for adjacent segment disease follows the same stepped approach as for primary spinal conditions — starting with conservative management and progressing to surgery when necessary.

1
Physical therapy and activity modification
Core strengthening and targeted physical therapy reduce mechanical stress on adjacent segments and can meaningfully improve symptoms, particularly for axial pain without significant nerve compression.
2
Anti-inflammatory medications and pain management
NSAIDs and short-term oral steroids can reduce inflammation associated with disc herniations or facet arthritis at the adjacent level. These are used as bridge therapy rather than long-term management.
3
Epidural steroid injections
Targeted epidural or foraminal steroid injections can provide meaningful relief of radicular (radiating) pain and help confirm the symptomatic level before any surgical decision-making.
4
Revision or extension surgery
When conservative measures fail or significant neurological compromise is present, surgery at the adjacent level is considered. Options include decompression alone (if the prior fusion is stable) or extension of the existing fusion construct. In select cervical cases, motion-preserving disc replacement at the adjacent level may be an option.
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The information on this page is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified physician regarding your specific condition. Surgery is not appropriate for every patient, and our physicians evaluate each case individually.
Related Conditions

Other Conditions We Treat

Cervical Myelopathy
Spinal cord compression
Disc Herniation
Cervical and lumbar
Spinal Stenosis
Canal narrowing
Neck Pain
Cervical degenerative disease
Back Pain
Lumbar and thoracic
Sciatica
Radiating leg pain
Patient Questions

Frequently Asked Questions

Adjacent segment disease (ASD) refers to the development of new or accelerated degenerative changes at spinal levels immediately above or below a prior spinal fusion. When a segment is fused, the motion that was previously shared across multiple levels becomes concentrated at the neighboring unfused levels, increasing mechanical stress and potentially accelerating wear. ASD can occur in the cervical or lumbar spine and may cause new or recurrent pain, nerve compression, or in the cervical spine, spinal cord compression (myelopathy).
Adjacent segment disease is a recognized long-term complication of spinal fusion. Studies suggest that radiographic (imaging) changes at adjacent levels are detectable in a significant proportion of fusion patients over time, though clinically symptomatic ASD requiring additional treatment is less common. The risk increases with the number of levels fused, the patient's age, pre-existing degeneration at neighboring levels, and the biomechanical demands placed on the spine.
Symptoms of adjacent segment disease typically mirror those of de novo degenerative spine disease but appear at a new level after a prior fusion. These include new neck or back pain, radiating arm or leg pain, numbness or tingling in a new distribution, and in cervical cases, signs of myelopathy such as hand clumsiness or gait instability. Symptoms often develop gradually, months to years after the original surgery, though they can also appear more acutely if a disc herniates at the adjacent level.
Many patients with adjacent segment disease can be managed with conservative measures including physical therapy, anti-inflammatory medications, activity modification, and epidural steroid injections. These approaches are often effective for controlling pain and managing radicular symptoms. Surgery is considered when conservative treatment has failed, when there is significant neurological compromise, or when imaging shows compression requiring decompression to prevent further nerve or cord damage.
Surgical treatment of adjacent segment disease typically involves decompression at the affected level, with or without extension of the existing fusion. In the cervical spine, this may mean an additional ACDF at the adjacent level, or in some cases, conversion of a prior fusion to a longer construct. In the lumbar spine, options include decompression alone or extension of fusion if instability is present. The choice depends on the patient's anatomy, the pattern of degeneration, and the findings at the original fusion level.
Cervical disc replacement (arthroplasty) preserves motion at the treated level and theoretically reduces the mechanical stress transferred to adjacent segments. Several studies and clinical trials suggest that motion preservation is associated with lower rates of symptomatic adjacent segment disease compared to fusion in selected patients. However, disc replacement is not appropriate for all patients, and the long-term evidence continues to develop. Our surgeons discuss this consideration during the initial consultation for patients who may be candidates.
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Clinical References
↗Park et al. — Adjacent Segment Disease Review ↗North American Spine Society ↗AANS — Spinal Fusion

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