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Retrospective cohort study. To assess long-term clinical outcomes of adjacent segment disease (ASD) in patients who underwent lumbar interbody fusion with percutaneous pedicle screw (PS) instrumentation. ASD is a well-known sequela of spinal fusion, and is reported to occur at a rate of 2%-3% per year. There is debate as to whether ASD is a result of the instrumentation and fusion method or is the natural history of the patient's disease. Minimally invasive percutaneous PS augmentation of lumbar interbody fusion aims to prevent the disr