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World Neurosurg. 2013 Dec;80(6):893-6. doi: 10.1016/j.wneu.2011.12.082. Epub 2011 Dec 24.

Laminectomy and extension of instrumented fusion improves 2-year pain, disability, and quality of life in patients with adjacent segment disease: defining the long-term effectiveness of surgery.

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Department of Neurosurgery, Vanderbilt University Medical Center, and Vanderbilt University Spinal Column Surgical Quality and Outcomes Research Laboratory, Nashville, Tennessee, USA.



Adjacent segment disease (ASD) may occur as a long-term consequence of spinal fusion and is associated with significant back and leg pain. Surgical management of symptomatic ASD consists of neural decompression and extension of fusion. However, conflicting results have been reported with respect to the long-term clinical effectiveness of revision surgery in this setting. We set out to comprehensively assess the long-term clinical outcome after revision surgery and determine its effectiveness in the treatment of adjacent segment disease.


Fifty patients undergoing revision surgery for ASD-associated back and leg pain were included in this study. Baseline and 2-year Visual Analog Scale-Back Pain (VAS-BP), Visual Analog Scale-Leg Pain (VAS-LP), Oswestry Disability Index, physical and mental quality of life (Short Form-12 [SF-12] physical and mental component score [PCS and MCS]) and health-state utility (EuroQol [EQ-5D]) were assessed.


A sustained improvement in VAS-BP (8.72 ± 1.85 vs. 3.92 ± 2.84, P = 0.001), VAS-LP (6.30 ± 3.90 vs. 3.02 ± 3.03, P = 0.001), Oswestry Disability Index (28.72 ± 9.64 vs. 18.48 ± 11.31, P = 0.001), SF-12 PCS (26.89 ± 8.85 vs. 35.58 ± 11.97, P = 0.001) and SF-12 MCS (44.66 ± 12.85 vs. 53.16 ± 9.46, P = 0.001) was observed 2 years after revision surgery, with a cumulative mean 2-year gain of 0.76 quality-adjusted life-years (EQ-5D). Median (interquartile range) time to narcotic independence and return to work was 1.7 (1.0-8.0) months and 2.0 (1.0-4.75) months, respectively.


Patients undergoing decompression and extension of fusion for adjacent segment disease-associated back and leg pain reported long-term improvement in pain, disability, and both physical and mental quality of life, suggesting that revision surgery is a highly effective treatment strategy in this patient population.


ASD; Adjacent segment disease; EQ-5D; EuroQol-5D; Fusion; IQR; Interquartile range; LP; Laminectomy; Leg pain; ODI; Oswestry Disability Index; Quality of life; SF-12; Short Form–12; VAS; Visual Analog Scale

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