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Background:   Adjacent-segment disease (ASD) is a well-described long-term complication after lumbar fusion. There is a lack of consensus about the risk factors for development of ASD, but identifying them could improve surgical outcomes. Our goal was to analyze the effect of patient characteristics and radiographic parameters on the development of symptomatic ASD requiring revision surgery after posterior lumbar fusion.    Methods:   In this retrospective cohort study, we identified patients who underwent lumbar fusion surgery and revision surgery from May 2012 to November 2018 using an institutional lumbar fusion registry. Patients having both pre- and post-operative upright radiographs were included in the study. Revision surgeries for which the index operation was performed at an outside hospital were excluded from analysis. Univariate analysis was conducted on candidate variables, and variables with  P &lt; 0.2 were selected for multivariate logistic regression.    Results:   Of the 106 patients identified, 21 required reoperation (29 months average follow-up). Age &gt;65 years (OR 4.14, 95% CI 1.46–11.76,  P = 0.008), body mass index (BMI) &gt;34 (OR 1.13, 95% CI 1.04–1.23,  P  = 0.004), and osteoporosis (OR 14, 95% CI 1.38–142.42,  P  = 0.03) were independent predictors of reoperation in the multivariate analysis. Increased facet diastasis at fusion levels (OR 0.60, 95% CI 0.42–0.85,  P  = 0.004) was associated with reduced reoperation rates. Change in segmental LL at the index operation level, rostral and caudal facet diastasis, vacuum discs, and T2 hyperintensity in the facets were not predictors of reoperation.    Conclusion:   Age &gt;65, BMI &gt;34, and osteoporosis were independent predictors of adjacent-segment reoperation after lumbar spinal fusion.

Age, body mass index, and osteoporosis are more predictive than imaging for adjacent-segment reoperation after lumbar fusion