Adjacent segment degeneration and disease after lumbar fusion compared with motion-preserving procedures: a meta-analysis.

PURPOSE: The purpose of our study was to compare lumbar fusion and motion-preserving procedures to determine whether lumbar fusion may be associated with a higher prevalence of adjacent segment degeneration (ASDeg) or adjacent segment disease (ASDis). METHODS: We performed a systematic review and meta-analysis for articles published up to July 2013. We included randomized controlled trials and cohort studies that reported ASDeg or ASDis after lumbar fusion compared with motion-preserving devices. Two authors independently extracted the articles and the predefined data. RESULTS: A total of 13 studies with 1,270 patients met our inclusion criteria and were included in the final analysis. Our analysis showed that the prevalence of ASDeg and ASDis, and adjacent segment reoperation rate in the fusion group were higher than those in the motion-preserving devices group (P < 0.0001, P = 0.0008, and P < 0.0001, respectively). The prevalence of ASDeg and reoperation rate in the motion-preserving devices group were significantly lower than that in the fusion group for both short- and long-term follow-up (P = 0.0008 and P = 0.001 at <5 years of follow-up; P = 0.003 and P = 0.001 at >5 years of follow-up). CONCLUSIONS: The current evidence suggests that lumbar fusion may result in a higher prevalence of adjacent segment degeneration or disease than motion-preserving procedures.