Usefulness of Ligament Reconstruction to Prevent Adjacent Segment Disease following Lumbar Fusion Surgery

Objective In this case series, we evaluated the potential of ligament reconstruction combined with open midline decompression following lumbar fusion surgery to mitigate adjacent segment disease (ASD). We focused on its capacity to reduce mechanical stress on adjacent segments and support spinal biomechanics. Methods This retrospective analysis included a case series of 32 patients who underwent lumbar fusion surgery with ligament reconstruction and open midline decompression. Radiological evaluations, including computed tomography and dynamic X-ray imaging, were performed preoperatively and postoperatively, with a mean follow-up of 19 months. ASD was assessed based on radiological criteria, including disc-height reduction, segmental instability, and facet-joint changes. Clinical outcomes were measured using the Visual Analog Scale (VAS) for back and leg pain. Results Radiological ASD was observed in four cases (12.5%) but not in 28 patients (87.5%). No ASD cases required reoperation. Only one patient from the entire cohort underwent additional surgery. Facet arthrodesis was identified in seven cases (21.9%), and five cases (15.6%) demonstrated cortical calcification around the facet joint. Postoperatively, the mean VAS scores for back and leg pain improved significantly. Conclusion Ligament reconstruction and open midline decompression provide dynamic stabilization by reducing hypermobility and mechanical stress on adjacent segments, which may help mitigate the risk of ASD following lumbar fusion surgery. This case series demonstrated a lower-than-expected incidence of radiological ASD and favorable clinical outcomes, suggesting that ligament reconstruction could serve as an effective motion-preserving alternative to traditional fusion, particularly for patients with a high ASD risk.