Management of degenerative disc disease above an L5-S1 segment requiring arthrodesis

Clear guidelines exist for treating spondylolisthetic deformity and instabi lity. How the surgeon handles adjacent-level degenerative disease is not as well established. Because magnetic resonance imaging now provides us with far more information on the "health" of radiographically normal interverteb ral discs, the treatment of dehydrated or degenerated discs adjacent to a f usion is becoming more problematic. In this discussion, two experts discuss their approach to symptomatic lumbosacral spondolisthesis accompanied by a djacent-level disc degeneration. Drs. Herkowitz and Abraham believe strongl y that the adjacent segment should be left alone, whereas Dr. Albert recomm ends extending the fusion in many instances.