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Think of the spine as a chain of repeating segments. When the entire spine is healthy, each segment works together to appropriately share and disperse stress throughout the spinal column. Each segment works with its neighboring segment to share the load from stresses caused by normal movements and forces. When one or more segments have been fused, the neighboring segments take on more load than they are designed to. Typically, the segments immediately adjacent to the fused level(s) bear most of this additional stress. Over time, this can lead to increased wear and tear on adjacent segments, ultimately causing new sources of neurologic impairment and/or discogenic pain.

While there appears to be some pain relief with extension of fusion, these studies indicate that this treatment strategy may accelerate degenerative processes at the newly created adjacent segments.1,2,3 These studies also reported significant complication rates. As intradiscal injections of fibrin and platelet rich plasma5,6,7,8 have been clinically demonstrated to have therapeutic value for discogenic pain, these minimally invasive alternatives may be worthwhile to consider before undergoing additional surgery.

1Chen WJ, Lai PL, Niu CC, Chen LH, Fu TS, Wong CB. Surgical treatment of adjacent instability after lumbar spine fusion. Spine (Phila Pa 1976). 2001; 26:E519–E524. doi:10.1097/00007632-200111150-00024 [CrossRef]

2Phillips FM, Carlson GD, Bohlman HH, Hughes SS. Results of surgery for spinal stenosis adjacent to previous lumbar fusion. J Spinal Disord. 2000; 13:432–437. doi:10.1097/00002517-200010000-00011 [CrossRef]

3Whitecloud TS III, Davis JM, Olive PM. Operative treatment of the degenerated segment adjacent to a lumbar fusion. Spine (Phila Pa 1976). 1994; 19:531–536. doi:10.1097/00007632-199403000-00007 [CrossRef]

4Yin W, Pauza K, Olan WJ, Doerzbacher JF, Thorne KJ. Intradiscal injection of fibrin sealant for the treatment of symptomatic lumbar internal disc disruption: results of a prospective multicenter pilot study with 24-month follow-up. Pain Med. 2014;15(1):16-31.

5Kirchner F, Anitua E. Intradiscal and intra-articular facet infiltrations with plasma rich in growth factors reduce pain in patients with chronic low back pain. J Craniovertebr Junction Spine. 2016;7(4):250-256.

6Monfett M, Harrison J, Boachie-adjei K, Lutz G. Intradiscal platelet-rich plasma (PRP) injections for discogenic low back pain: an update. Int Orthop. 2016;40(6):1321-8.

7Levi D, Horn S, Tyszko S, Levin J, Hecht-leavitt C, Walko E. Intradiscal Platelet-Rich Plasma Injection for Chronic Discogenic Low Back Pain: Preliminary Results from a Prospective Trial. Pain Med. 2016;17(6):1010-22.

8Tuakli-wosornu YA, Terry A, Boachie-adjei K, et al. Lumbar Intradiskal Platelet-Rich Plasma (PRP) Injections: A Prospective, Double-Blind, Randomized Controlled Study. PM R. 2016;8(1):1-10.

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