Our Summary

This research paper investigates the most effective surgical treatment for adjacent segment disease (ASD), a condition that affects the spine. The researchers aimed to understand whether a decompression procedure or an extension of fusion is necessary for treating ASD, especially in cases where the disease involves narrowing of the spinal canal with or without instability of the spine.

To do this, they conducted a comprehensive search of multiple medical databases for studies on surgical treatments of ASD. They found 662 studies, but only 5 were relevant to their investigation. These 5 studies involved a total of 118 patients.

The researchers found that the preferred treatment for ASD in all studies was the extension of fusion. After the surgery, overall improvements in back and/or leg pain were noted in around 71.3% of the patients and successful fusion in the spine was observed in about 89.3% of the patients. However, the rate of needing another surgery after the first one ranged from 4.5% to 23.1%.

The study concluded that the clinical outcomes after spinal fusion for ASD can vary greatly. They also highlighted a lack of information on the best treatment options for patients with ASD, which can involve narrowing of the spinal canal with or without instability of the spine.

FAQs

  1. What is the most effective surgical treatment for adjacent segment disease (ASD) according to the research?
  2. What percentage of patients showed improvements in back and/or leg pain after the extension of fusion surgery?
  3. What was the rate of patients needing another surgery after the first one according to the study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lumbar fusion is to follow post-operative instructions carefully, including proper wound care, physical therapy, and avoiding activities that can put strain on the spine. It is important to attend all follow-up appointments with the surgeon to monitor progress and address any concerns. In addition, maintaining a healthy lifestyle with regular exercise and a balanced diet can help support the healing process and prevent future complications.

Suitable For

Patients who are typically recommended lumbar fusion are those with adjacent segment disease (ASD) involving narrowing of the spinal canal with or without instability of the spine. These patients may experience symptoms such as back and/or leg pain, weakness, numbness, and difficulty walking. Lumbar fusion may be recommended when conservative treatments such as physical therapy, medications, and injections have not provided relief, and the condition is causing significant impairment in daily activities.

Timeline

Before lumbar fusion:

  • Patient experiences chronic back and/or leg pain that does not respond to conservative treatments such as physical therapy or medication
  • Patient undergoes diagnostic tests such as MRI or CT scans to determine the cause of the pain
  • Patient consults with a spine surgeon to discuss surgical options
  • Patient undergoes preoperative evaluations and tests to ensure they are a good candidate for surgery

After lumbar fusion:

  • Patient undergoes lumbar fusion surgery, which involves the fusion of two or more vertebrae in the spine
  • Patient stays in the hospital for a few days for postoperative care and monitoring
  • Patient undergoes physical therapy to help with recovery and rehabilitation
  • Patient may experience some pain and discomfort initially after surgery, but this typically improves over time
  • Patient follows up with their surgeon for postoperative appointments to monitor their progress and address any concerns

What to Ask Your Doctor

Some questions a patient should ask their doctor about lumbar fusion include:

  1. What are the potential risks and complications associated with lumbar fusion surgery?
  2. How long is the recovery process after lumbar fusion surgery?
  3. Will I need physical therapy or rehabilitation after the surgery?
  4. What is the success rate of lumbar fusion surgery for treating my specific condition?
  5. Are there any alternative treatments or less invasive options available for my condition?
  6. How long will the effects of the fusion last and will I need additional surgeries in the future?
  7. How soon can I expect to see improvement in my symptoms after the surgery?
  8. What type of anesthesia will be used during the surgery?
  9. How many lumbar fusion surgeries have you performed and what is your experience with this procedure?
  10. Are there any lifestyle changes or precautions I should take after the surgery to ensure the best outcome?

Reference

Authors: Drysch A, Ajiboye RM, Sharma A, Li J, Reza T, Harley D, Park DY, Pourtaheri S. Journal: Orthopedics. 2018 Mar 1;41(2):e161-e167. doi: 10.3928/01477447-20170621-02. Epub 2017 Jun 30. PMID: 28662247