Adjacent segment disease

Symptoms attributed to changes in a spinal segment next to a fusion, distinct from imaging changes without symptoms.

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Understanding the mechanism

Adjacent segment disease means symptoms associated with a spinal level near a surgically treated region, particularly after fusion. It differs from adjacent degeneration seen on an image without symptoms. Changes can reflect both natural ageing and altered loading after surgery. They do not automatically demonstrate a surgical error or failure, and identifying the actual symptomatic lesion remains necessary.

Symptoms and warning signs

New pain, radiculopathy or claudication may appear after a period of improvement. The presentation depends on the level and lesion, which may involve a disc, facet, stenosis or slip. Progressive weakness or walking difficulty needs urgent assessment. New urinary retention, loss of bladder or bowel control, or saddle numbness requires immediate emergency care rather than waiting for a physical-care appointment.

Diagnosis and investigations

Assessment compares the new symptoms with the original history and checks neurological status. Radiographs evaluate alignment and hardware; MRI and CT answer complementary questions. Sacroiliac pain, hip disease, failed fusion or infection can also explain the presentation. Adjacent arthritis on a scan is insufficient by itself to confirm the source or justify another operation.

Treatment and outlook

Management depends on the cause, stability and disability. Individualized rehabilitation and medical pain management may be appropriate, while selected compression or instability requires surgical discussion. Extending a fusion is not automatic. Overall spinal balance and functional goals should be considered rather than treating an isolated image without understanding how the person stands, walks and performs daily activities.

The role of TAGMED care

At TAGMED, fused levels, implants, healing status and restrictions must be documented before care. Motorized decompression is not automatically suitable after a fusion. Manual procedures should not attempt to force movement through a fused segment. Laser and shockwave therapy cannot repair failed hardware, and suspected postoperative complications require input from the surgical team rather than an empirical device-based treatment.

Practical follow-up

Good coordination specifies what has changed since the last surgical assessment and which restrictions still apply. Follow-up should also consider activities actually limited. Radiographic changes without new disability do not automatically require intervention, but new neurological findings need appropriate reassessment.

Frequently asked questions

Is every nearby degenerative change a disease?

No. Adjacent segment disease requires symptoms clinically linked to that level.

Is surgery always the cause?

Surgery can alter loads, but ageing and other factors also contribute.

Must the fusion always be extended?

No. The lesion, stability and response to suitable conservative options guide the decision.

Is manual treatment ever appropriate?

Sometimes, with clear restrictions and without forcing the fused region.

Which records are useful?

The operation report, treated levels, relevant imaging and the surgeon's follow-up instructions.

Educational information from The Spine Page. This entry does not replace an individual assessment. Documentary version: October 12, 2026. Sylvain Desforges, B.Sc., D.O., N.D., osteopath and naturopath.