More Adjacent Segment Disease Cases

Eight years after a successful spinal fusion, Chris started losing ground — worsening back pain and a spine that was slowly bending him forward. This is adjacent segment disease, and in his case it came with a second problem: a spinal alignment issue that a simple fusion extension wouldn't fix. In this video we walk through Chris's X-rays and MRI, why he was standing bent forward and holding a bar to stay upright, and the reconstruction we chose — a pedicle subtraction osteotomy at L5 to rebuild the curve his spine had lost. Timestamps: 0:00 Meet Chris — 74, eight years after an L4–S1 fusion 0:30 Reading the X-rays: why Chris stood bent forward 2:12 Adjacent segment disease plus an alignment problem 3:11 The measurement that mattered: 20° of lordosis where 35–40° is normal 4:40 Why the plan had to reach into the thoracic spine 5:40 The surgery — a pedicle subtraction osteotomy at L5 7:16 Nine months later About this case: Chris is a 74-year-old man who had an L4–S1 fusion eight years ago for leg pain. He did well until the last couple of years, when he developed worsening low back pain and a forward-leaning posture. His X-rays showed the bones below had solidly fused — this was not a pseudarthrosis — but above the fusion his lumbar spine had reversed into a lumbar kyphosis, and he was compensating by straightening his thoracic spine and bending his knees to keep his eyes level. This is sagittal imbalance. His L4–S1 segment held only about 20 degrees of lordosis, where 35 to 40 degrees is typical. His MRI showed disc degeneration and stenosis at L2–L3 and L3–L4, and his thoracic spine had bridging osteophytes from T11 up — a naturally stiff, auto-fused segment that made a good landing point. To restore his lordosis where it physiologically belongs, we performed a pedicle subtraction osteotomy at L5 — cutting a wedge out of the vertebra to swing the spine back into a normal curve — and extended the fusion up to T10. At nine months he is walking well with almost no back pain. This is one of several adjacent segment disease cases in this series. Adjacent segment disease means the level above or below a prior fusion begins to break down; it can be purely radiographic or clinically significant, and when it comes with a deformity, the solution is usually bigger than a single-level extension. About Dr. Francis Lovecchio: Dr. Lovecchio is an orthopedic spine surgeon at Hospital for Special Surgery in New York City, specializing in adult spinal deformity, scoliosis, and revision spine surgery. Website: https://www.drlovecchio.com