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
Prospective study of a new dynamic stabilisation system in the treatment of degenerative discopathy and instability of the lumbar spine
Antonino Zagra,Leone Minoia,Marino Archetti,A. S. Corriero,K. Ricci,Marco Teli,Fabrizio Giudici +6 more
TL;DR: The 1 year follow-up shows that the tested PDS system is able to provide a significant improvement in pain and disability scores when applied to patients affected by DLSI, and the system does not provide better clinical results when compared to similar trials on posterior fusion.
Intraoperative reduction does not result in better outcomes in low-grade lumbar spondylolisthesis with neurogenic symptoms after minimally invasive transforaminal lumbar interbody fusion—a 5-year follow-up study
TL;DR: Intraoperative reduction does not improve outcomes in LGLS with neurogenic symptoms after MIS TLIF andequate decompression and solid fusion are likely the keys to good mid-term outcomes.
Risk factors for adjacent segment degeneration after surgical correction of degenerative lumbar scoliosis
TL;DR: Patients over the age of 65 years and with preoperative disc degeneration (as revealed by plain radiograph and MRI) were at a higher risk of developing ASD.
Polyetheretherketone (PEEK) Rods in Lumbar Spine Degenerative Disease: A Case Series.
TL;DR: PEEK rods demonstrate a similar fusion and reoperation rate in comparison to other instrumentation modalities in the treatment of degenerative lumbar spine disease.
Prevention of Adjacent Segmental Disease after Fusion in Degenerative Spinal Disorder: Correlation between Segmental Lumbar Lordosis Ratio and Pelvic Incidence-Lumbar Lordosis Mismatch for a Minimum 5-Year Follow-up.
Whoan Jeang Kim,Chang Hyun Ma,Sang Ha Kim,Yeon Seung Min,Jae Won Lee,Shann Haw Chang,Kyung Hoon Park,Kun Young Park,Dae Gun Song,Won Sik Choy +9 more
TL;DR: Patients with a postoperative L4–5– S1/L1–S1 lordosis ratio >50% had less occurrence of ASD, and Correcting LL according to PI and physiologic segmentalLordosis ratio is important in preventing ASD.
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.
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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.
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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.
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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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