Discuss the problem of adjacentlevel degeneration following lumbar fusion

Lumbar fusion results in load transfer to unfused proximal and distal spinal segments resulting in increased intradiscal pressure and increased intersegmental motion at neighboring spinal segments. This may result in radiographic degenerative changes in the adjacent spinal segments (adjacent segment degeneration) and symptoms requiring additional surgical intervention (adjacent segment disease). It has been estimated that the rate of adjacent segment disease (development of symptoms sufficiently severe to require additional surgery for decompression or arthrodesis) is 4% per year for the first 10 years following a lumbar arthrodesis procedure. Whether the radiographic and clinical findings are a result of the iatrogenically created rigid spinal segment or progression of the natural history of an underlying degenerative process remains controversial.

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