Accelerated Degeneration of the Segment Adjacent to a Lumbar Fusion

Lee, Casey K.

doi:10.1097/00007632-198803000-00029

Cited by 649 publications

(276 citation statements)

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“…This does not mean that the second disc will not be influenced by the procedure. Accelerated degeneration of the facet joints adjacent to a lumbar fusion has been described by Lee [16]. Implant removal at 9 months could interfere with the posterior spondylodesis, accelerating the return to the preoperative RA values.…”

Section: Ramentioning

confidence: 92%

Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients

et al. 2001

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Section: Ramentioning

confidence: 92%

Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients

et al. 2001

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“…Adjacent segment degeneration describes nearly any abnormal process that develops in the mobile segment next to a spinal fusion and although the exact mechanism remains uncertain, altered biomechanical stresses (hypermobility, olisthesis, disc height (DH) loss, instability) appear to play a key role in its development [4,16,19,30,33,34,39,47]. Although several clinical and radiological criteria have been introduced to define segmental spinal instability there is no consensus as regard its definition.…”

Section: Introductionmentioning

confidence: 99%

“…Although most often the criteria to determine ASD are based solely on radiographic findings [2,7,19,28,30,34,39,41,59] reporting an ASD incidence ranging from 8 to 100%, the symptomatic incidence of ASD is significantly lower ranging from 5.2 to 18.5% [7,28,31], while the rate of re-operation rate for symptomatic ASD ranges from 2.7 to 20% [16,58].…”

Section: Introductionmentioning

confidence: 99%

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

et al. 2009

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Delayed complications following lumbar spine fusion may occur amongst which is adjacent segment degeneration (ASD). Although interspinous implants have been successfully used in spinal stenosis to authors' knowledge such implants have not been previously used to reduce ASD in instrumented lumbar fusion. This prospective controlled study was designed to investigate if the implantation of an interspinous implant cephalad to short lumbar and lumbosacral instrumented fusion could eliminate the incidence of ASD and subsequently the related reoperation rate. Groups W and C enrolled initially each 25 consecutive selected patients. Group W included patients, who received the Wallis interspinous implant in the unfused vertebral segment cephalad to instrumentation and the group C selected age-, diagnosis-, level-, and instrumentationmatched to W group patients without interspinous implant (controls). The inclusion criterion for Wallis implantation was UCLA arthritic grade \II, while the exclusion criteria were previous lumbar surgery, severe osteoporosis or degeneration[UCLA grade II in the adjacent two segments cephalad to instrumentation. All patients suffered from symptomatic spinal stenosis and underwent decompression and 2-4 levels stabilization with rigid pedicle screw fixation and posterolateral fusion by a single surgeon. Lumbar lordosis, disc height (DH), segmental range of motion (ROM), and percent olisthesis in the adjacent two cephalad to instrumentation segments were measured preoperatively, and postoperatively until the final evaluation. VAS, SF-36, and Oswestry Disability Index (ODI) were used. One patient of group W developed pseudarthrosis: two patients of group C deep infection and one patient of group C ASD in the segment below instrumentation and were excluded from the final evaluation. Thus, 24 patients of group W and 21 in group C aged 65? 13 and 64? 11 years, respectively were included in the final analysis. The follow-up averaged 60 ± 6 months. The instrumented levels averaged 2.5 ? 1 vertebra for both groups. All 45 spines showed radiological fusion 8-12 months postoperatively. Lumbar lordosis did not change postoperatively. Postoperatively at the first cephalad adjacent segment: DH increased in the group W (P = 0.042); ROM significantly increased only in group C (ANOVA, P \ 0.02); olisthesis decreased both in flexion (P = 0.0024) and extension (P = 0.012) in group W. The degeneration or deterioration of already existed ASD in the two cephalad segments was shown in 1 (4.1%) and 6 (28.6%) spines in W and C groups, respectively. Physical function (SF-36) and ODI improved postoperatively (P \ 0.001), but in favour of the patients of group W (P \ 0.05) at the final evaluation. Symptomatic ASD required surgical intervention was in 3 (14%) patients of group C and none in group W. ASD remains a significant problem and accounts for a big portion of revision surgery following instrumented lumbar fusion. In this series, the Wallis interspinous implant changed the natural history of ASD and saved th...

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“…Introduction Mobile segment changes above the level of fusion have been reported by many authors [6,8,11,12,13,17], and the level immediately above the fusion is thought to be at high risk due to the altered biomechanics following fusion. Sagittal plane abnormalities caused by fusion, advanced age of the patient and use of rigid pedicle instrumentation have been held responsible for the involvement of levels above the fusion.…”

mentioning

confidence: 99%

Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease

2000

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Accelerated Degeneration of the Segment Adjacent to a Lumbar Fusion

Cited by 649 publications

References 0 publications

Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients

Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease

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