Global Spine J 2014; 04(02): 083-088
DOI: 10.1055/s-0034-1370693
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Incidence of Adjacent Segment Breakdown in Polysegmental Thoracolumbar Fusions of Three or More Levels with Minimum 5-Year Follow-up

Edward P. Abraham1, 2, 3, Neil A. Manson1, 2, 3, Melissa D. McKeon1
  • 1Department of Orthopaedic Surgery, Canada East Spine Centre, Saint John Regional Hospital, Saint John, New Brunswick, Canada
  • 2Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  • 3Faculty of Medicine, Memorial University of Newfoundland, Newfoundland, Canada
Further Information

Publication History

18 January 2013

13 January 2014

Publication Date:
25 February 2014 (eFirst)


Study Design Retrospective cohort study.

Objective To identify the incidence of adjacent segment pathology (ASP) after thoracolumbar fusion of three or more levels, the risk factors for the development of ASP, and the need for further surgical intervention in this particular patient population.

Methods A retrospective analysis of a prospective surgical database identified 217 patients receiving polysegmental (≥ 3 levels) spinal fusion with minimum 5-year follow-up. Risk factors were evaluated, and the following data were obtained from the review of radiographs and charts: radiographic measures—levels fused, fusion status, presence of ASP; clinical measures—patient assessment, Oswestry Disability Index (ODI), and the need for further surgery.

Results The incidence of radiographic ASP (RASP) was 29%; clinical or symptomatic ASP (CASP), 18%; and those requiring surgery, 9%. Correlation was observed between ODI and ASP, symptomatic ASP, and need for revision surgery. Age, preoperative degenerative diagnosis, and absence of fusion demonstrated significant association to ASP.

Conclusions ASP was observed in a significant number of patients receiving polysegmental fusion of three or more levels. ODI scores correlated to RASP, CASP, and the need for revision surgery.