Akademik Veri Yönetim Sistemi
Journal of Turkish Spinal Surgery, cilt.36, sa.1, ss.10-16, 2025 (Hakemli Dergi)
Objective: Adjacent segment disease (ASD) is a complication commonly associated with spinal instrumentation; it usually requires further
surgery and deteriorates the quality of life of patients. Although many studies have been conducted regarding the risk factors of ASD in short-
segment surgeries, the literature regarding long-segment posterior instrumentation with pelvic screws and transforaminal lumbar interbody
fusion is limited. Therefore, this study evaluated the incidence, cause, and outcome of ASD in such cases.
Materials and Methods: This retrospective study included 127 patients who underwent long-segment posterior instrumentation between
January 2010 and December 2017. Among them, 15 developed symptomatic ASD requiring revision surgery. The diagnostic criteria
encompassed >20% intervertebral disc height reduction, >5° angulation on flexion-extension X-rays, >3 mm sagittal translation, and facet
joint degeneration.
Results: The overall revision rate was 11%. The median follow-up duration was 107 months, with mean of 114±23 months. There were 9
females and 6 males in the ASD cohort, with a mean age of 65.7±5.3 years, compared with a mean age of 62.9±7.6 years for non-ASD patients.
The most common level for ASD to occur was T9-10 (p<0.05). Advanced age, degenerative changes, and the absence of vertebroplasty or
cemented screws had a significant contribution.
Conclusion: ASD is a significant complication of long-segment posterior instrumentation. The strategy for identifying high-risk patients,
particularly by modifiable factors like age >65, smoking, and determination of the upper instrumented vertebra, has important implications
for prevention. Prophylactic vertebroplasty and use of cemented screws may reduce ASD risk.
Keywords: Spine, lumbar vertebrae, sakrum, spinal fusion