Adjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients

Abstract

This retrospective study investigated adjacent segments radiologically and clinically after posterolateral fusion of the lumbar spine with instrumentation. Thirty-two patients over 60 years old with a postoperative follow-up of at least 4 years were included. These patients all met the criteria of a postoperative symptom-free period of over 2 years, evident fusion mass seen on plain radiographs, and no implant breakage or loosening. There was 81.3% excellent and good clinical results (26/32). For all patients, flexion and extension views of the lumbar spine were done preoperatively and postoperatively. Adjacent segments below the fusion, above the fusion, and cranial to the above adjacent segment were examined. Three patients each with translation > 4 mm in adjacent segments were found in both the short and long (> or = 3 segments) fusion groups. The incidence was 16.7% (3/18) in the short fusion group and 21.4% (3/14) in the long fusion group. However, no statistically significant difference (p = 0.7878) was found according to the Fisher exact test. Comparing the effect of different types of instruments, there still was no statistically significant difference (p = 0.1161) between the VSP plate and Isola rod groups in inducing degeneration of adjacent segments after posterolateral fusion of the lumbar spine. After measuring the mobility of degenerated adjacent segments, relative hypermobility was more likely responsible for the accelerated degeneration rather than the absolute increase of mobility.

Risk factors for adjacent segment disease after lumbar fusion

“…'Adjacent segment disease' has been used to designate the development of new clinical symptoms that are compatible with radiographic changes adjacent to the level of a previous spinal fusion. Although studies on the adjacent segment problem are now in active progress, but most of them have utilized radiographic findings as a diagnostic tool rather than for symptomatology [2,5,[7][8][9][10]19]. However, we suggest that discussion about the adjacent segment changes irrelevant to clinical findings is not so meaningful.…”

“…We also found that the incidence of distal ASD was much lower than that of proximal ASD. The exact statistical data have not been collected, but several other clinical studies have demonstrated similar tendencies [1,2,5,7]. This may be due to the recessed position of the L5-S1 segment within the pelvis restrained by iliolumbar ligaments [9].…”

Does hybrid fixation prevent junctional disease after posterior fusion for degenerative lumbar disorders? A minimum 5-year follow-up study

“…While the evolution and prevalence of ASD are not fully known, there is increasing evidence in literature that its effects may be seen soon after fusion surgery and in as many as 30 % of patients [3,4]. Cheh et al reported a rate of clinical ASD of 30.3 % and showed that patients in whom adjacent level disease developed had significantly worse Oswestry Disability Index scores than those without adjacent level disease.…”

“…Achievement of fusion may, in fact, have long-term effects on the immediately adjacent motion segments [3,4]. At the junction with adjacent mobile segments, the rigidity of the fused segments induces increased constraints that can constitute a clinical concern [5][6][7].…”

Dynamic stabilization devices in the treatment of low back pain

“…[1] Several studies in the recent literature questioned the efficacy of spinal fusion in the treatment of low back pain. [2] In addition, a significant apprehension of adjacent segment disease in the long term follow-up after spinal fusion always concerned the spinal [3][4][5][6][7][8] surgeon.…”