Introduction: Although the number of symptomatic adjacent segment disease (ASD) after lumbar fusion surgery is increasing, there is no definitive strategy of surgical selection for symptomatic ASD, and a few study discussed based on Health-Related QOL evaluation. The purpose of this study was to investigate the outcome of revision surgery for ASD using Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) .

Methods: 51 patients (23 male, 30 female, mean age of 68.9 years) who underwent surgery for symptomatic ASD and were assessed using JOABPEQ before and one year after the surgery were included in this study. We divided the patients into two groups, that is decompression alone (D group) and the other is decompression with fixation (F group), and evaluated in demographic data (age, sex, BMI, past history), surgical factor (surgical procedure, rate of complications and re-operation), preoperative X-ray parameters and instability of the affected level (segmental slip > 20%, dynamic slip >10%, segmental angulation > 5 degrees, and lateral translation > 3mm), and JOABPEQ effectiveness rate.

Results: There were 19 cases in group D (spinous process-splitting laminoplasty), 34 cases in group F (PSF: 1 case, PLIF: 31 cases, XLIF + PSF: 2 cases). No significant differences were observed in age, preoperative X-ray parameters between the two groups, however, the frequency of female was significantly higher in the F group than in the D group (78.4% vs 19.2% ; p = 0.01). BMI was significantly lower in the F group than D group (23.1 vs 25.6 ; p = 0.01). The rate of complications and re-revision surgery did not show significant differences (p=0.62, 1.00, respectively). Preoperative instability of the affected level was observed in 5 patients in the group D (25.0%) and 28 patients in the Group F (84.8%), which was significantly higher in the group F (p<0.01).The JOABPEQ effective rate for each domain were Social life function (p=0.84), Low back pain (p=0.70), Lumbar function (p=0.82), Mental health (p=0.70), and walking ability (p=.0.70), indicating that there were no significant differences between the two groups.  

Discussion: From our study, symptomatic ASD was dominant in female. With regard to surgical outcome based on patient-based questionnaire for symptomatic ASD, there were no significant differences between the two procedures, suggesting that ASD patients without instability could be treated by decompression alone.