What is Adjacent Level Disease?
Adjacent level disease (ALD) refers to degeneration that develops at the levels next to a prior spinal fusion.
A spinal fusion stabilizes a segment of the spine by eliminating motion at that level. While this can effectively treat the original problem, it also changes the biomechanics of the spine, placing increased stress on the levels above and below the fusion.
Over time, this added stress can accelerate degeneration at adjacent segments.
Why Does This Happen?
After a fusion:
- The fused segment no longer moves
- Nearby segments must compensate with increased motion and load
- This can lead to:
- Disc degeneration
- Facet joint arthritis
- Ligament thickening
- Spinal stenosis or instability
This process can be more pronounced if spinal alignment was not fully optimized during the initial surgery, further increasing mechanical strain on adjacent levels.
Symptoms
Symptoms of adjacent level disease are often similar to the original condition and may include:
- Neck or back pain
- Radiating arm or leg pain
- Numbness or tingling
- Weakness
- Difficulty with walking or daily activities
In some cases, patients may also develop new instability or deformity over time.
What is Revision Spinal Fusion?
When symptoms become significant and do not respond to conservative treatment, revision spine surgery may be necessary.
Revision surgery involves:
- Addressing the new area of degeneration
- Relieving nerve compression
- Extending or modifying the existing fusion when appropriate
Treatment Options
Conservative Management
As with most spine conditions, treatment often begins with:
- Physical therapy
- Activity modification
- Pain management procedures, including injections
Some patients can achieve meaningful relief without surgery.
Surgical Treatment (Revision Surgery)
When symptoms are persistent or progressive, surgery is often required.
Revision procedures are highly individualized and may include:
- Decompression of affected nerves
- Extension of fusion to additional levels
- Correction of alignment, if needed
Because prior surgery alters normal anatomy, revision procedures are often more complex and require careful planning.
Our Approach
We take a comprehensive and highly individualized approach to patients with prior spinal fusion.
Evaluation includes:
- Detailed review of prior surgery
- Advanced imaging such as CT SPECT
- Assessment of spinal alignment and biomechanics
Our goal is not only to treat the current problem, but also to optimize overall spinal balance to reduce the risk of further degeneration.
When surgery is indicated, we utilize modern techniques and thoughtful surgical planning to safely perform revision procedures while minimizing additional disruption to surrounding tissues.
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