Trial reportEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2009
A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration.
Trial report in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 93 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
93 citing papers in PubMed, 3 syntheses or guidelines pooled it, 212 citations in OpenAlex.
- Comparison between spinal fusion vs. nonoperative treatment for lumbar degenerative pathology: a systematic review and meta-analysis.Neurosurgical review · 2025Pooled it
- Impact of iatrogenic alterations on adjacent segment degeneration after lumbar fusion surgery: a systematic review.Journal of orthopaedic surgery and research · 2025Pooled it
- Surgery for adult spondylolisthesis: a systematic review of the evidence.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2016Pooled it
- Long-term (> 10 years) clinical outcomes of instrumented posterolateral fusion for spondylolisthesis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2021Trial
- Trial
- Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol.BMC musculoskeletal disorders · 2012Trial
- Cationized gelatin nanosphere-mediated release-controlled RNA interference targeting mTORC1 protects against intervertebral disc degeneration.Bioactive materials · 2027Article
- Radiographic and Clinical Adjacent Segment Disease After Posterior Instrumented Fusion for Traumatic Thoracolumbar and Lumbar Vertebral Fractures.Journal of clinical medicine · 2026Article
- The Relationship Between Postoperative Variation of Adjacent Segment Three-Dimensional Kinematics and Postoperative PI-LL in Patients With Degenerative Lumbar Scoliosis After Short Segment Fixation.Orthopaedic surgery · 2025Article
- The importance of the posterior osteoligamentous complex of the lumbar spine: dogma changing biomechanical insights.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- Biomechanical restoration in unilateral facet arthroplasty: a cadaveric evaluation.North American Spine Society journal · 2025Article
- Impact of Sagittal Spinal Balance on Functional Recovery After PLIF of L5-S1 Isthmic Spondylolisthesis With Lumbar Spinal Stenosis.Orthopaedic surgery · 2025Article
- Gender Differences in Outcomes in Patients Treated for Thoracolumbar Burst Fractures Without Neurological Deficits: Prospective International Multicenter Study.Neurosurgery · 2025Article
- How to prevent preoperative adjacent segment degeneration L5/S1 segment occuring postoperative adjacent segment disease? A retrospective study of risk factor analysis.Journal of orthopaedic surgery and research · 2025Review
- Risk factors and treatment strategies for adjacent segment disease following spinal fusion (Review).Molecular medicine reports · 2025Review
- Article
- Article
- Comparison of Clinical Efficacy in the Treatment of Lumbar Degenerative Disease: Posterior Lumbar Interbody Fusion, Posterior Lumbar Fusion, and Hybrid Surgery.International journal of spine surgery · 2024Article
- Adjacent segment degeneration at a minimum 2-year follow-up after posterior lumbar interbody fusion: the impact of sagittal spinal proportion: a retrospective case series.Asian spine journal · 2024Article
- Risk Factors of Unsatisfactory Outcomes Requiring Additional Intervention Following Oblique Lateral Interbody Fusion.Neurospine · 2024Article
33 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The existence and importance of an accelerated adjacent segment disc degeneration (ASD) after lumbar fusion have previously not been demonstrated by RCTs. The objectives of this study were, to determine whether lumbar fusion in the long term accelerates degenerative changes in the adjacent disc and whether this affects the outcome, by using a prospective randomised design. A total of 111 patients, aged 18-55, with isthmic spondylolisthesis were randomised to exercise (EX, n = 34) or posterolateral fusion (PLF, n = 77), with (n = 37) or without pedicle screw instrumentation (n = 40). The minimum 10 years FU rate was 72%, with a mean FU time of 12.6 years (range 10-17 years). Three radiographic methods of ASD quantification were used, i.e. two digital radiographic measurement methods and the semi quantitative UCLA grading scale. One digital measurement method showed a mean disc height reduction by 2% in the EX group and by 15% in the PLF group (p = 0.0016), and the other showed 0.5 mm more disc height reduction in the PLF compared to the Ex group (ns). The UCLA grading scale showed normal discs in 100% of patients in the EX group, compared to 62% in the PLF group (p = 0.026). There were no significant differences between instrumented and non-instrumented patients. In patients with laminectomy we found a significantly higher incidence of ASD compared to non laminectomised patients (22/47 vs. 2/16 respectively, p = 0.015). In the longitudinal analysis, the posterior and anterior disc heights were significantly reduced in the PLF group, whereas in the EX group only the posterior disc height was significantly reduced. Except for global outcome, which was significantly better for patients without ASD, the clinical outcome was not statistically different in patients with and without ASD. In conclusion, the long-term RCT shows that fusion accelerates degenerative changes at the adjacent level compared with natural history. The study suggests that not only fusion, but also laminectomy may be of pathogenetic importance. The clinical importance of ASD seems limited, with only the more severe forms affecting the outcome.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.