Adjacent Level Disease

Adjacent level disease is a post-operative complication of spinal fusion surgery in which the fusion of one or more motion segments affects the joints above and below it, causing the breakdown of joints. The motion segments of the spine describe the complex of two vertebrae, the intervertebral disc between them, and the facet joints and other connective tissues that support it and move it. In some cases, it is considered appropriate to eliminate one or more of these motion segments by removing the disc between them and fusing them together with rods, screws, plates, and bone grafts. This is what happens in a typical spinal fusion surgery.

This type of surgery is considered to be appropriate for patients with significant nerve damage that involves debilitating pain and failed attempts at other neck pain treatments, such as physical therapy, medications, anti-inflammatory medications. Recovery times following a spinal fusion procedure are among the longest for any type of surgery.

Adjacent level disease is one of the serious complications of the fusion option because it may throw off the alignment of the spine, and put pressure on the other joints due to the loss of mobility in the motion segment that was eliminated. The fusion of the bones may affect the joints of the motion segments above and below it, causing them to show signs of arthropathy that weren't present before the fusion procedure. Due to these complications, patients may be required to have further operations to address this damage of the joints above and below it.



Most people who watch or play sports are familiar with injuries that occur in one part of the body. When that part of your body does become injured, you do what you can not to use it or put weight on it until the pain has subsided. This is usually a logical and correct response to injury. Unfortunately, as you change the ways you carry your body around, you may cause yourself to get injuries in other areas of the body because you are not using it in a balanced way. Putting more pressure on the joints caused them to become injured, which is a side effect of the original injury.

Likewise, a fusion surgery affects that entire section of the spine, including the motion segments immediately above and below it, to the point that the spine moves and bends differently, due to this loss in flexibility.

In a January 2004 article in the Journal of Neurosurgery, doctors presented evidence that about 75% of patients who received spine fusion surgery showed evidence of adjacent level disease. This fusion procedure actually causes the degeneration of the joints above and below it. The presence of joint disease in the nearby joints was confirmed through MRI (Magnetic Resonance Imaging) radiologic results.

The MRI images looked at the motion segments above and below the fused vertebra. Doctors carefully analyzed the disc height, indentation of the fecal sac, disc height, diameter of the spinal canal. Over 50% of the patients had disc degenerations in either the one above or below the fused vertebrae. It is important to note that no patients experienced symptoms during the time from when they had the surgery to the time of the MRI study related to these new changes in the disc. Though the results showed that the damage was there and possible progressing. Other medical imaging technologies that may be used to determine the health of the discs include X-Rays and CT Scans.

There are several factors that may affect a patient's chances that they will be affected by adjacent level disease. For example, post-menopausal women are more likely to be affected.

The must move our bodies around from the time we wake up in the morning to the time we go to bed at night. We need to turn our heads, bend forwards and backwards, and move our backs and necks sideways. This motion has to come from somewhere, and if one part of the spine is fused together, the other motion segments will have to do extra work. The other disc and joints have to do the extra work, which puts more pressure on these joints that they may not have been designed to handle.

Adjacent level disease is also known as Adjacent Segment Degeneration - ASD.