{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:06:50Z","timestamp":1784074010601,"version":"3.55.0"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,10]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Posterior or transforaminal lumbar interbody fusion (PLIF\/TLIF) has become the standard procedure for treating degenerative lumbar diseases. With the increasing number of surgeries, adjacent segment disease (ASD) is becoming widely known as a postoperative complication. However, the association between lumbosacral sagittal alignment and ASD following L4\u20135 isolated fusion surgery has not been fully elucidated. The aim of this study was to identify the preoperative radiological risk factors for L3\u20134 ASD and L5\u2013S1 ASD independently after isolated L4\u20135 PLIF\/TLIF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors retrospectively reviewed the data of 151 patients with degenerative lumbar diseases who underwent isolated L4\u20135 PLIF\/TLIF at their institution between April 2013 and August 2022. L3\u20134 ASD and L5\u2013S1 ASD were evaluated separately, and these groups were compared with the non-ASD group. Radiological ASD was defined as disc height (DH) loss (&gt; 3 mm), posterior opening (&gt; 5\u00b0) on flexion, or progression of slippage (&gt; 3 mm) as observed on plane radiographs. Symptomatic ASD was defined as the presence of symptoms attributable to the adjacent segment that required revision surgery within 2 years. Preoperative lumbosacral parameters, including slippage at L4\u20135 (Meyerding grade), pelvic tilt, sacral slope, pelvic incidence (PI), lumbar lordosis (LL), PI-LL, L1 sagittal vertical axis (SVA), and L4 SVA, were measured using standing radiographs. Intraoperative distraction at the L4\u20135 DH, preoperative disc degeneration (Pfirrman grade), vacuum phenomenon, foraminal stenosis, and additional decompression at adjacent segments were also evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Of 151 unique patients, 31 (20.5%) had ASD, with 20 (13.2%) included in the L3\u20134 ASD group and 13 (8.6%) included in the L5\u2013S1 ASD group (2 patients were included in both groups). Multivariate analysis revealed that additional L3\u20134 decompression and distraction at L4\u20135 DH were significantly associated with L3\u20134 ASD, whereas L1 SVA &gt; L4 SVA (L1 plumb line anterior to the L4 plumb line) was associated with L5\u2013S1 ASD. The risk of L5\u2013S1 ASD increased by a factor of 4.13 (p = 0.004) in patients with sagittal imbalance, as indicated by L1 SVA &gt; L4 SVA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>These findings suggest distinct characteristics between L3\u20134 ASD and L5\u2013S1 ASD. L3\u20134 ASD was not associated with lumbosacral sagittal imbalance. By contrast, an anterior shift of the lumbar loading axis, as indicated by L1 SVA &gt; L4 SVA, was associated with the development of L5\u2013S1 ASD. Preoperative L1 SVA &gt; L4 SVA might serve as a convenient predictive parameter for L5\u2013S1 ASD after isolated L4\u20135 fusion surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.2.spine251490","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:01:24Z","timestamp":1783468884000},"page":"1-8","source":"Crossref","is-referenced-by-count":0,"title":["Different risk factors for early-onset adjacent segment disease at L3\u20134 and L5\u2013S1 segments after isolated L4\u20135 lumbar fusion surgery: 2-year follow-up"],"prefix":"10.3171","author":[{"given":"Toshiyuki","family":"Kitaori","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Kitano Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Ota","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kitano Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiro","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kitano Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiko","family":"Saji","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kitano Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Ishibashi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kitano Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kitano Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiyuki","family":"Asada","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Kitano Hospital, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"15","key":"b1","series-title":"J Bone Joint Surg Am","first-page":"1438","article-title":"Demographic, surgical, and radiographic risk factors for symptomatic adjacent segment disease after lumbar fusion: a systematic review and meta-analysis","volume":"103","author":"Lau KKL","year":"2021","unstructured":"Lau KKL, Samartzis D, To NSC, Harada GK, An HS, Wong AYL. 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Spine (Phila Pa 1976). 2004;29(17):1938\u20131944. doi:10.1097\/01.brs.0000137069.88904.03"},{"issue":"7","key":"b4","series-title":"Spine J","first-page":"1112","article-title":"Risk factors for early-onset radiographical adjacent segment disease in patients with spondylolytic spondylolisthesis after single-level posterior lumbar interbody fusion","volume":"22","author":"Takeda K","year":"2022","unstructured":"Takeda K, Okada E, Shinozaki Y,  Risk factors for early-onset radiographical adjacent segment disease in patients with spondylolytic spondylolisthesis after single-level posterior lumbar interbody fusion. Spine J. 2022;22(7):1112\u20131118. doi:10.1016\/j.spinee.2022.02.001"},{"key":"b5","series-title":"J Orthop Surg Res","first-page":"39","article-title":"Does pre-existing L5-S1 degeneration affect outcomes after isolated L4-5 fusion for spondylolisthesis?","volume":"10","author":"Choi KC","year":"2015","unstructured":"Choi KC, Shim HK, Kim JS, Lee SH. 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Asian Spine J. 2018;12(4):743\u2013748. doi:10.31616\/asj.2018.12.4.743"},{"issue":"11","key":"b11","series-title":"Eur Spine J","first-page":"1946","article-title":"Adjacent segment degeneration after single-segment PLIF: the risk factor for degeneration and its impact on clinical outcomes","volume":"20","author":"Chen BL","year":"2011","unstructured":"Chen BL, Wei FX, Ueyama K, Xie DH, Sannohe A, Liu SY. Adjacent segment degeneration after single-segment PLIF: the risk factor for degeneration and its impact on clinical outcomes. 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