The Management Options of Adjacent Segment Disease (ASD)

Adjacent Segment Disease (ASD) is a recognized long-term complication following spinal fusion and may progress from radiographic adjacent segment degeneration to symptomatic disease causing axial pain, radiculopathy, deformity, or instability. As spinal fusion procedures continue to increase, ASD has become an increasingly important clinical problem. Its management requires an individualized approach based on symptom severity, neurological status, structural instability, deformity, previous fusion construct, and patient factors. Nonoperative treatment remains the first-line strategy in patients without progressive neurological deficit or significant instability and includes analgesia, physical therapy, activity modification, lifestyle optimization, and image-guided injections. Surgery is considered when conservative and interventional measures fail, or when neurological compromise, instability, or deformity is present. Surgical management ranges from targeted decompression for isolated neural compression to revision fusion strategies for cases with instability, deformity, or advanced degeneration. Open revision remains important for complex deformity, multilevel disease, and severe instability, while minimally invasive and robotic approaches may reduce soft tissue disruption, blood loss, perioperative morbidity, and recovery time. This chapter reviews the principles of ASD management, outlines conservative, interventional, and surgical treatment options, and illustrates minimally invasive and robotic revision strategies through representative cases.