Journal Article10.1097/BRS.0B013E31814B2D8E
Adjacent segment disease followinglumbar/thoracolumbar fusion with pedicle screw instrumentation: a minimum 5-year follow-up.
Gene Cheh,Keith H. Bridwell,Lawrence G. Lenke,Jacob M. Buchowski,Michael D. Daubs,Yongjung J. Kim,Christy Baldus +6 more
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TL;DR: Age at surgery over 50 years and length of fusion were significant risk factors for the development of ASD in the lumbar spine and Circumferential fusion versus posterior-only fusion was not a significant factor in theDevelopment of ASD.
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Abstract: Study design Retrospective radiographic outcomes analysis. Objective We had 3 hypotheses: 1) a longer fusion; 2) a more proximal instrumented vertebra, and 3) circumferential fusion versus posterior-only fusion would increase the likelihood of adjacent segment disease (ASD). Summary of background data The literature analyzing risk factors, prevalence, and presentation of patients with ASD is varied and without clear consensus. Methods A total of 188 patients with minimum 5-year follow-up who had lumbar/thoracolumbar fusion with pedicle screw instrumentation for degenerative disorders were included. Radiographic ASD was defined by: 1) development of spondylolisthesis >4 mm, 2) segmental kyphosis >10 degrees , 3) complete collapse of disc space, or 4) more than 2 grades worsening of Weiner classification. Clinical ASD was defined as 1) symptomatic spinal stenosis, 2) intractable back pain, or 3) subsequent sagittal or coronal imbalance. Results Radiographic ASD occurred in 42.6% (80 of 188) of patients. Patients with radiographic ASD had worse Oswestry scores (20.3 vs. 12.5; P = 0.001) at ultimate follow-up than those without ASD. Clinical ASD developed in 30.3% (57 of 188) of patients. Clinical ASD manifested as spinal stenosis (n = 47), instability-type back pain (n = 5), and sagittal or coronal imbalance (n = 5). Age at surgery over 50 years and length of fusion were significant risk factors for the development of ASD in the lumbar spine. Fusion to L1-L3 proximally increased the risk of ASD when compared with L4 and L5. Circumferential fusion versus posterior fusion was not a significant factor in the development of ASD. Conclusion Patients over the age of 50 were at higher risk of developing clinical ASD than those 50 years old or younger. Length of fusion was a significant risk factor in the development of ASD in the lumbar spine. Fusion up to L1-L3 increased the risk of ASD when compared with L4 and L5. Circumferential fusion, as opposed to posterolateral fusion, was not a statistically significant risk factor for the development of ASD.
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Citations
Long-term Treatment Effects of Lumbar Arthrodeses in Degenerative Disk Disease: A Systematic Review With Meta-Analysis.
Andriy Noshchenko,Lilian Hoffecker,Emily M. Lindley,Evalina L. Burger,Christopher M J Cain,Vikas V. Patel +5 more
TL;DR: This review indicates that surgical stabilization of the lumbar spine is an effective treatment for LS; in particular, for patients with severe chronic low back pain that has been resistant to ≥3 months of conservative therapy.
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Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Provides Sustained Improvements in Clinical and Radiological Outcomes up to 5 Years Postoperatively in Patients with Neurogenic Symptoms Secondary to Spondylolisthesis.
TL;DR: Single-level instrumented MIS-TLIF is suitable for patients with neurogenic symptoms secondary to lumbar spondylolisthesis and is associated with an acceptable complication rate.
Quantification of intradiscal pressures below thoracolumbar spinal fusion constructs: is there evidence to support "saving a level"?
Joshua D. Auerbach,Baron S. Lonner,Thomas J. Errico,Andrew L. Freeman,Derek Goerke,Brian P. Beaubien +5 more
TL;DR: The relative biomechanical protection resulting from “saving a level” in long spinal fusions was quantified to quantify the relative pressure changes that occur in the unfused caudal discs with progressively longer fusions.
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Dynamic Constructs for Spinal Fusion: An Evidence-Based
Michael P. Kelly,James M. Mok,Sigurd Berven +2 more
- 01 Jan 2010
TL;DR: A review and assessment of the evidence in the literature on the efficacy of dynamic stabilization techniques in the management of spinal disorders is presented in this paper. But, the authors do not consider the effect of instrumentation on adjacent segments.
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Long-term outcome of targeted therapy for low back pain in elderly degenerative lumbar scoliosis
Kiyotaka Yamada,Toshio Nakamae,Kazuyoshi Nakanishi,Naosuke Kamei,Takeshi Hiramatsu,Teruaki Okuda,Takashi Hashimoto,Satoshi Ujigo,Taiki Morisako,Yuji Tsuchikawa,Toshiaki Maruyama,Hiroki Fukui,Nobuo Adachi,Takuro Shimbo,Kjell Olmarker,Yoshinori Fujimoto +15 more
TL;DR: In this article, percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI) targeting to the interbretebral vacuum as a minimally invasive surgery was compared to that of nonoperative treatment.
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References
Adjacent Segment Degeneration in the Lumbar Spine
TL;DR: Although there was a trend toward progression of the arthritic grade at the adjacent disc levels, there was no significant correlation, with the numbers available, between the preoperative arhritic grade and the need for additional surgery.
Lumbosacral Spinal Fusion A Biomechanical Study
Casey K. Lee,Noshir A. Langrana +1 more
TL;DR: This biomechanical study investigates the altered kinematics and biomechanics of the three different types of spinal fusion (posterior, bilateral-lateral, and anterior) on the adjacent, unfused segment as well as within the fused segment and to investigate their clinical implications.
528
The fate of the adjacent motion segments after lumbar fusion
TL;DR: Questions are raised about the justification of fusion procedures in degenerative conditions of the spine without threatening instability in a homogeneous group of patients operated on during a 14-year period for degenerative Conditions of the lumbar spine resistant to conservative treatment.
369
Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders.
TL;DR: To prevent postoperative instability, attention must be paid especially above the fusion levels of the elderly and the preoperative minimal anterior translation.
339
Magnetic resonance imaging assessment of disc degeneration 10 years after anterior lumbar interbody fusion
TL;DR: The findings of this study suggest that degeneration after an anterior lumbar interbody fusion is determined more by individual characteristics than by the fusion itself.
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