Adjacent Segment Disease

What is adjacent segment disease (ASD)?

Adjacent segment disease (ASD) happens when areas of the spine next to a previous spinal fusion begin to wear down over time. During fusion surgery, two or more bones in the spine are joined together to improve stability and reduce painful movement.

Because the fused bones no longer move independently, the areas above and below the fusion may take on added stress and movement. Over time, this added strain can lead to wear and tear in nearby discs and joints, causing symptoms such as pain, stiffness or nerve irritation.

Find a location

Illustration comparing a healthy cervical spine to one with spondylosis, labeled with bulging disk, bone spurs, and narrowed disk space.

How spinal fusion can affect the spine

Your spine is made up of bones, discs and joints that work together to help you move, bend and stay flexible. After a spinal fusion, nearby areas of the spine may work harder to support everyday movement, which can place extra stress on surrounding spinal segments.

Not everyone who has spinal fusion surgery develops ASD, but the condition can occur gradually over time.

Overview

Symptoms

Symptoms of adjacent segment disease (ASD) can vary depending on how severe the degeneration is and where it is located. They may develop gradually or become more noticeable over time and include:

New or returning neck or back pain
Stiffness or reduced flexibility
Numbness, tingling or weakness in the arms or legs
Pain that travels along a nerve pathway
Difficulty standing, walking or completing daily activities

Causes

There are several factors that can lead to adjacent segment disease including:

Increased stress on the spinal levels next to a fusion
Natural age-related changes in the spine
Pre-existing disc or joint degeneration
Changes in spinal alignment
Smoking or repetitive high-impact activities

Diagnosis

Your spine specialist will review your symptoms, history of previous spine surgery, how your condition affects your daily life and conduct a physical examination to check strength, balance and movement. Your specialist may also order imaging such as X-rays, MRI or CT scans that can help show changes near the spinal fusion and areas of degeneration.

Why treatment matters

Novant Health specialists can work closely with you to create a personalized treatment plan focused on relieving your symptoms. Early treatment can help reduce pain, improve mobility and prevent symptoms from worsening and may include physical therapy, medications, lifestyle modifications or image-guided injections.

If nonsurgical treatments don’t help to relieve your symptoms, your doctor may recommend surgery to relieve pressure on nerves or improve spinal stability.