ABSTRACT
Adjacent degenerative disease (ADD) to spinal fusion has long been recognized and suspected (Figs. 1,2). With the advancement of spinal instrumentation, ADD has become an issue with which to contend when recommending spinal fusion to patients who are candidates for spinal fusion. In 1988, Lee (1) reported on 18 patients who had developed ADD at least one year following lumbar fusion. The range prior to the development of ADD was 3 to 38 years with a mean of 15.2 years. Eleven of these patients had developed new symptoms within five years of their fusion. With the exception of one, the rest had developed ADD above the lumbar fusion. Nine patients were treated with extension of the initial spinal fusion to include the adjacent level. Four of these same cases required a third operation for ADD above the second fusion.
