Will Spinal Fusion at One Level in the Low Back Mean a Second Fusion Later?The fusion dilemma: Fusing a part of the spine often gives immediate pain relief. But is it worth it if you end up needing another fusion later? There's some debate over whether fusion at one level causes increased stress and load above and below the fusion. This can cause many problems, which the author of this study calls adjacent motion segment alterations (AMSAs).
AMSAs include dehydration of the disc, disc space narrowing, bone spurs, ligament bulging, and changes in alignment of the spine. But how often do AMSAs really happen? That's the focus of this study from the University Hospital in Belgium.
Only patients with degenerative conditions of the spine were included. Everyone was fused for a minimum of five years. Some patients were in the study for up to 15 years. Besides having only one type of back condition, all patients were treated with spinal fusion by the same doctor.
The author found that the longer a patient has had the fusion, the greater the chance for AMSAs. After five years, the number of patients with AMSAs jumped from 29 to 41 percent. Reoperation was needed more often when the spine was fused at three or four levels (instead of just one or two levels).
Other risk factors may be linked to AMSAs, including age and obesity. Heavy work after fusion is a risk factor even in young patients with fusions at only one or two levels. AMSAs are less likely when the patient has a partial fusion or single-level fusion.
The results of this study point out the need to rethink spinal fusion for degenerative disc disease. More than one-third of the patients developed AMSAs, and half of those ended up having more surgery. The author of this study concludes that more research is needed to find better treatment options.
Philippe Gillet. The Fate of the Adjacent Motion Segments after Lumbar Fusion. In Journal of Spinal Disorders & Techniques. August 2003. Vol. 16. No. 4. Pp. 338-345.
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