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

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Study Design

Retrospective cohort study.


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.


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.


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.


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.

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