{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T12:23:18Z","timestamp":1783686198320,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Adjacent segment disease (ASD) after spinal fusion is well described in degenerative cohorts, but its radiographic and clinical behavior after acute traumatic thoracolumbar fracture fusion remains incompletely defined. This study evaluated whether ASD after traumatic fusion represents an imaging finding alone or a clinically relevant recovery-limiting event. Methods: This retrospective study included 98 patients who underwent posterior instrumented thoracolumbar\/lumbar fusion for acute traumatic vertebral fractures. Because urgent surgery precluded meaningful preoperative disability assessment, the 1-month postoperative Oswestry Disability Index (ODI) was used as an early post-treatment functional reference point. Radiographic ASD was defined by new or progressive adjacent-level disc degeneration, disc-space narrowing, translation, angular instability, or junctional kyphosis, whereas clinical ASD was defined strictly as revision-confirmed symptomatic adjacent pathology. Results: Radiographic ASD occurred in 54 patients (55.1%), whereas revision-confirmed clinical ASD occurred in 11 patients (11.2%). Proximal and distal involvement were observed in 39.8% and 36.7% of patients, respectively. ODI improved from 42.5 \u00b1 15.4 at 1 month to 27.0 \u00b1 10.9 at final follow-up. Radiographic ASD alone was not associated with worse functional recovery. In contrast, revision-confirmed clinical ASD identified patients with markedly reduced ODI improvement (4.4 \u00b1 2.8 vs. 16.9 \u00b1 17.0; p = 0.007), and no patient with revision-confirmed clinical ASD achieved the ODI minimum clinically important difference. Conclusions: ASD after traumatic fusion should be interpreted as a clinically stratified phenomenon: frequently radiographic, but clinically relevant primarily when revision-confirmed and associated with reduced ODI-based recovery.<\/jats:p>","DOI":"10.3390\/jcm15145416","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T11:43:34Z","timestamp":1783683814000},"page":"5416","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiographic and Clinical Adjacent Segment Disease After Posterior Instrumented Fusion for Traumatic Thoracolumbar and Lumbar Vertebral Fractures"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2661-7581","authenticated-orcid":false,"given":"Ali B\u00fclent","family":"Baz","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, University of Health Science, 07100 Antalya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2766-5083","authenticated-orcid":false,"given":"Vugar","family":"Nabi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, University of Health Science, 07100 Antalya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7392-3058","authenticated-orcid":false,"given":"Fatih","family":"Duygun","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, University of Health Science, 07100 Antalya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6716-4542","authenticated-orcid":false,"given":"\u00d6mer Faruk","family":"K\u0131l\u0131\u00e7aslan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Antalya Training and Research Hospital, University of Health Science, 07100 Antalya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2227-2173","authenticated-orcid":false,"given":"Aliekber","family":"Yapar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine, Akdeniz University, 07100 Antalya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4056-3743","authenticated-orcid":false,"given":"Mehmet Ali","family":"Tokg\u00f6z","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, 07100 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1097\/01.brs.0000137069.88904.03","article-title":"Adjacent segment disease after lumbar or lumbosacral fusion: Review of the literature","volume":"29","author":"Park","year":"2004","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.2106\/00004623-200407000-00020","article-title":"Adjacent segment degeneration in the lumbar spine","volume":"86","author":"Ghiselli","year":"2004","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"190S","DOI":"10.1016\/j.spinee.2004.07.007","article-title":"Adjacent segment degeneration and adjacent segment disease: The consequences of spinal fusion?","volume":"4","author":"Hilibrand","year":"2004","journal-title":"Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"811","DOI":"10.3174\/ajnr.A4173","article-title":"Systematic literature review of imaging features of spinal degeneration in asymptomatic populations","volume":"36","author":"Brinjikji","year":"2015","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1016\/j.spinee.2020.05.100","article-title":"Current incidence of adjacent segment pathology following lumbar fusion versus motion-preserving procedures: A systematic review and meta-analysis of recent projections","volume":"20","author":"Donnally","year":"2020","journal-title":"Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1016\/j.spinee.2013.03.020","article-title":"Adjacent segment disease in the lumbar spine following different treatment interventions","volume":"13","author":"Radcliff","year":"2013","journal-title":"Spine J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1097\/00002517-199512000-00008","article-title":"Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders","volume":"8","author":"Aota","year":"1995","journal-title":"J. Spinal Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1007\/s00586-009-1060-3","article-title":"Risk factors for adjacent segment disease after lumbar fusion","volume":"18","author":"Lee","year":"2009","journal-title":"Eur. Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E339","DOI":"10.1097\/BRS.0000000000000164","article-title":"Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion: Comparison of posterior lumbar interbody fusion and posterolateral fusion","volume":"39","author":"Lee","year":"2014","journal-title":"Spine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1227\/NEU.0000000000000627","article-title":"Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine disease","volume":"76","author":"Ou","year":"2015","journal-title":"Neurosurgery"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2527","DOI":"10.1097\/01.brs.0000144408.02918.20","article-title":"Relation between laminectomy and development of adjacent segment instability after lumbar fusion with pedicle fixation","volume":"29","author":"Lai","year":"2004","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1007\/s00402-011-1343-0","article-title":"Disc space distraction is a potent risk factor for adjacent disc disease after PLIF","volume":"131","author":"Kaito","year":"2011","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.clineuro.2016.02.004","article-title":"Adjacent segment degeneration after posterior lumbar fusion: An analysis of possible risk factors","volume":"143","author":"Ghasemi","year":"2016","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s13018-014-0097-0","article-title":"Risk factors for predicting symptomatic adjacent segment degeneration requiring surgery in patients after posterior lumbar fusion","volume":"9","author":"Liang","year":"2014","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1055\/s-0033-1349331","article-title":"Preoperative predictable factors for the occurrence of adjacent segment degeneration requiring second operation after spinal fusion at isolated L4\u2013L5 level","volume":"75","author":"Cho","year":"2014","journal-title":"J. Neurol. Surg. A Cent. Eur. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1097\/01.brs.0000256875.17765.e6","article-title":"Radiologic assessment of all unfused lumbar segments 7.5 years after instrumented posterior spinal fusion","volume":"32","author":"Vidal","year":"2007","journal-title":"Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1007\/s00586-009-0947-3","article-title":"A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration","volume":"18","author":"Ekman","year":"2009","journal-title":"Eur. Spine J."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Wang, X., Wu, X.D., Zhang, Y., Zhu, Z., Jiang, J., Li, G., Liu, J., Shao, J., and Sun, Y. (2023). The necessity of implant removal after fixation of thoracolumbar burst fractures\u2014A systematic review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12062213"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1007\/s00776-005-0956-y","article-title":"Thoracolumbar injury classification and severity score: A new paradigm for the treatment of thoracolumbar spine trauma","volume":"10","author":"Lee","year":"2005","journal-title":"J. Orthop. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S111","DOI":"10.1097\/00007632-200112151-00019","article-title":"Post-traumatic spinal deformity","volume":"26","author":"Vaccaro","year":"2001","journal-title":"Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2218","DOI":"10.1097\/00007632-199610010-00008","article-title":"The ideal amount of lumbar foraminal distraction for pedicle screw instrumentation","volume":"21","author":"Infusa","year":"1996","journal-title":"Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/BRS.0000000000001654","article-title":"Preventive effect of dynamic stabilization against adjacent segment degeneration after posterior lumbar interbody fusion","volume":"42","author":"Tachibana","year":"2017","journal-title":"Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"43","DOI":"10.22603\/ssrr.2019-0003","article-title":"Preoperative risk factors for adjacent segment degeneration after two-level floating posterior fusion at L3\u2013L5","volume":"4","author":"Ushio","year":"2019","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1007\/s00586-008-0695-9","article-title":"Union versus nonunion after posterolateral lumbar fusion: A comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis","volume":"17","author":"Tsutsumimoto","year":"2008","journal-title":"Eur. Spine J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.4184\/asj.2016.10.6.1149","article-title":"Bone union rate following instrumented posterolateral lumbar fusion: Comparison between demineralized bone matrix versus hydroxyapatite","volume":"10","author":"Nam","year":"2016","journal-title":"Asian Spine J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2940","DOI":"10.1097\/00007632-200011150-00017","article-title":"The Oswestry Disability Index","volume":"25","author":"Fairbank","year":"2000","journal-title":"Spine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1097\/BRS.0b013e31815e3a10","article-title":"Interpreting change scores for pain and functional status in low back pain: Towards international consensus regarding minimal important change","volume":"33","author":"Ostelo","year":"2008","journal-title":"Spine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.spinee.2007.11.006","article-title":"Minimum clinically important difference in lumbar spine surgery patients: A choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales","volume":"8","author":"Copay","year":"2008","journal-title":"Spine J."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Liu, J., Wu, L., Zhang, A., Qiu, X., Liu, Z., and Yuan, X. (2026). Clinical and radiographic outcomes of adjacent segment degeneration after short-segment fixation for lumbar vertebral fracture. Front. Surg., 13.","DOI":"10.3389\/fsurg.2026.1780109"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/00024720-200308000-00005","article-title":"The fate of the adjacent motion segments after lumbar fusion","volume":"16","author":"Gillet","year":"2003","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_31","first-page":"e53861","article-title":"Assessment of health-related quality of life in patients with traumatic fractures following thoracolumbar fusion: Short-term results","volume":"16","author":"Kapetanakis","year":"2024","journal-title":"Cureus"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5416\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T12:08:13Z","timestamp":1783685293000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5416"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":31,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145416"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145416","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]}}}