Demographic, Surgical, and Radiographic Risk Factors for Symptomatic Adjacent Segment Disease After Lumbar Fusion: A Systematic Review and Meta-Analysis

Kenney Lau, Dino Samartzis, Nicholas To, Garrett Harada, Howard An, Yu Lok Wong (Corresponding Author)

Research output: Journal article publicationJournal articleAcademic researchpeer-review

1 Citation (Scopus)


Background: Although multiple studies have investigated risk factors for symptomatic adjacent segment disease (ASD) after lumbar fusion, their findings were diverse and inconsistent. This review aimed to summarize risk factors for ASD in order to guide the management of ASD and future research.

Methods: Six electronic databases were systematically searched from inception to December 2019. Two reviewers independently screened titles, abstracts, and full-text articles to identify studies investigating risk factors for ASD after lumbar fusion in humans. The methodological quality of the included studies and the strength of evidence regarding risk factors were evaluated.

Results: Sixteen studies involving 3,553 patients were included. Meta-analyses revealed that high body mass index, facet joint violation, anterior shift of the preoperative and postoperative lumbosacral sagittal plumb line, decreased preoperative and postoperative lumbar lordosis, preoperative adjacent disc degeneration, decreased preoperative adjacent disc height, increased postoperative lumbopelvic mismatch, postoperative pelvic incidence, and postoperative pelvic tilt were significantly related to ASD.

Conclusions: This meta-analysis addressed the limitations of prior reviews and summarized evidence with regard to risk factors for ASD following lumbar fusion. Future prospective studies should investigate whether modification of these risk factors can reduce the ASD development.

Level of evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Original languageEnglish
Pages (from-to)1438-1450
Number of pages13
JournalJournal of Bone and Joint Surgery - Series A
Issue number15
Early online date24 Jun 2021
Publication statusPublished - 4 Aug 2021

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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