You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Prevalence of Adjacent Segment Degeneration After Spine Surgery: A Systematic Review and Meta-analysis

Xia, Xiao-Peng MD*; Chen, Hong-Lin MM; Cheng, Hong-Bin MM*

doi: 10.1097/BRS.0b013e318273a2ea
Literature Review

Study Design. Systematic review of published prevalence of adjacent segment degeneration (ASD) after spine surgery.

Objective. To evaluate the prevalence of ASD in patients after cervical and lumbar spine surgery.

Summary of Background Data. ASD is a common complication after spine surgery in long-term follow-up. A large body of literature has been reported on the topic, but no meta-analysis of the epidemiological data on ASD has been published

Methods. We searched the MEDLINE until March 2012 published in English language that reported the prevalence of ASD after spine surgery. We determined the ASD rates by calculating proportions and 95% confidence interval (CI) for each study and then pooled the data to derive a pooled proportion and 95% CI.

Results. A total of 94 studies with 34,716 patients from 19 countries were included. The occurrence of radiograph ASD ranged from 4.8% to 92.2%, and the pooled prevalence was 29.3% (95% CI, 22.7%–35.8%) by the random-effects model. The occurrence of symptoms ASD ranged from 0.0% to 30.3%, and the pooled prevalence was 7.4% (95% CI, 6.4%–8.5%). In cervical position, the occurrence of radiograph ASD and symptoms ASD was 32.8% (95% CI, 17.8%–47.9%) and 6.3% (95% CI, 4.8%–7.8%); in lumbar position, the occurrence of radiograph ASD and symptoms ASD was 26.6% (95% CI, 21.3%–31.9%) and 8.5% (95% CI, 6.4%–10.7%). In the 0.5- to 2- or less, more than 2- to 5- or less, and more than 5- to 20- or less year diagnosis time, the radiograph ASD prevalence was 21.8% (16.0%–27.6%), 33.6% (21.8%–45.4%), and 37.4% (10.7%–64.1%), respectively; and the symptoms ASD prevalence was 6.5% (4.8%–8.1%), 12.1% (8.2%–16.0%), and 3.2% (2.5%–4.0%), respectively.

Conclusion. Spine surgery is associated with significant risk of ASD. These figures may be useful in the estimation of the burden of the ASD after spine surgery.

In Brief

To evaluate the prevalence of adjacent segment degeneration (ASD) in patients after spine surgery, we searched the MEDLINE and included the studies. The data were pooled by the random-effects model for meta-analysis The pooled prevalence of radiograph ASD was 29.3%, and symptoms ASD was 7.4%.

Author Information

*Department of Orthopaedics, Traditional Chinese Medical Hospital of Nantong City, Nantong, Jiangsu, China; and

Nantong University. Nantong, Jiangsu, China.

Address correspondence and reprint requests to Xiao-Peng Xia, MD, Department of Orthopaedics, Traditional Chinese Medical Hospital of Nantong City, Jianshe Rd #41, Nantong, Jiangsu, China; E-mail:

Acknowledgment date: May 3, 2012. Revision date: July 29, 2012. Acceptence date: September 8, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Nantong City Social Development Projects funds were received to support this work (project nos. S2010036 and HS2012032).

No relevant financial activities outside the submitted work.

© 2013 Lippincott Williams & Wilkins, Inc.