Long-Term Risks of Spinal Fusion

What If ASD Develops?

If you have no symptoms, no treatment is needed. Even if imaging shows changes, that alone is not a reason for surgery.

• Mild symptoms: Pain medication, rehabilitation, and exercise therapy are used while monitoring your progress
• Severe symptoms affecting daily life: Surgery may be recommended to decompress or stabilize the newly affected level

From the guideline commentary:

Whether or not implants were used does not significantly affect the rate of adjacent segment changes. This means ASD is not exclusively a fusion problem — it can also occur after decompression alone. However, patients who already have degeneration at adjacent levels before surgery tend to have worse outcomes, and those with advanced degeneration have higher rates of new leg symptoms and reoperation.

A prospective database analysis found that the reoperation rate at up to 5 years was approximately 14%, regardless of whether fusion was performed.