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I just had my annual physical complete with X-rays to check on my L4-5 lumbar fusion. It looks like the level above is starting to go now. I don't have any pain or symptoms. I would never have known this was happening without the X-ray. Should I just ignore it? Or is it best to have it fused before it starts causing problems?

You are describing a problem linked with spinal fusion called adjacent segment degeneration (ASD). It's believed that mechanical pressures or malalignment in the spine generates enough force through the fused segment to cause deterioration of the bone and soft tissues at the next level (above or below the fused site). Many patients don't even know there is anything changing at the adjacent levels. Like yourself, without an X-ray, no one is the wiser. But despite significant changes, there may be no signs or symptoms of a problem. When pain or other symptoms occur, surgery may be indicated to stabilize the spine. More often, a wait-and-see approach is taken. Fusing another level doesn't always solve the problem. It can make things worse because the original problem hasn't been dealt with and now there's a second surgery. And experts agree that X-ray evidence of ASD doesn't necessarily mean you'll end up with any problems. It might be best to sit down with your surgeon and go over the results of this exam. Be prepared with any questions you have. Weigh all the pros and cons and consider all your options before coming to a firm decision about what to do next.

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