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Studies have shown that lumbar fusion may lead to increased degeneration at the adjacent level. However, the issue of further degeneration around the fusion area is controversial. There is debate whether it is the natural history of progressive degeneration or increased stress from the fusion which causes the further degeneration. Goal of our study was to compare the incidence of progressive degeneration and need for subsequent surgery between patients who were treated nonsurgically or with fusion for a thoracic or lumbar level fracture.Material and Methods   The commercially available PearlDiver database and insurance billing codes were used to identify 3,699 patients diagnosed with thoracic fracture and 5,016 patients diagnosed with lumbar fracture in 2007. For both the thoracic and lumbar fracture cohorts, patients were divided into subgroups based on procedural codes: those who underwent fusion surgery and those who were treated nonsurgically. Each of those subgroups was further divided into patients who were diagnosed with intervertebral disc degeneration within1, 2, and 3 years from their initial treatment, and of those patients, how many had a follow-up surgery. We used chi-squared statistical analysis to compare incidences of disc degeneration and follow-up surgery between the fusion and nonsurgical groups.Results   Of the 3,699 patients diagnosed with thoracic fracture, 3,215 (86.9%) were treated nonsurgically and 117 (3.2%) underwent thoracic fusion surgery within 90 days. Within 3 years, 147 patients from the nonsurgical subgroup and fewer than 11 from the fusion subgroup were diagnosed with thoracic disc degeneration. From the nonsurgical subgroup, 11 (0.3%) patients underwent a thoracic surgery related to disc degeneration, compared with zero from the fusion group ( p &gt; 0.05). From 5,016 patients diagnosed with lumbar fracture, 4,371 (87.1%) were treated nonsurgically and 150 (3.0%) underwent lumbar fusion. Within 3 years, 503 (11.5%) patients from the nonsurgical and 35 (23.3%) from the fusion subgroup were diagnosed with lumbar disc degeneration ( p &lt; 0.05). From the nonsurgical subgroup, 42 went on to have lumbar surgery related to disc degeneration, compared with fewer than 11 from the fusion subgroup (exact number suppressed because of the privacy limitations).Conclusion   In the thoracic region, fusion surgery as treatment for thoracic fracture does not appear to increase the likelihood of disc denegation and future surgery compared with conservative treatments. On the contrary, in the lumbar region, initial fusion surgery appears to increase the incidence of disc degeneration and future surgeries, as well as nonsurgical procedures.

Effects of Fusion and Conservative Treatment on Disc Degeneration and Rates of Subsequent Surgery after Thoracolumbar Fracture