Adjacent segment degeneration after posterior lumbar fusion: An analysis of possible risk factors

Ghasemi, Amir Abbas

doi:10.1016/j.clineuro.2016.02.004

Cited by 35 publications

(37 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…e surgical simulation and ASD risk evaluation in this segment would have decreased the accuracy and credibility of our study. In addition, published literature PED by novice surgeons PED by experienced surgeons has illustrated that ASD was more common in the cranial rather than in the caudal segments [35,36]. e simulation of PED in the L4-L5 segment allowed us to analyze the variation in ASD risk at the L3-L4 segment, a segment in which natural disc degenerative changes are far less common than in L4-L5 and L5-S1 segments, and get a more credible conclusion.…”

Section: Discussionmentioning

confidence: 99%

Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element Analysis

Wang

Jiang

et al. 2020

BioMed Research International

View full text Add to dashboard Cite

Background. Translaminar percutaneous endoscopic discectomy (PED) was used widely in the treatment of lumbar disc herniation (LDH), especially for the training of novice surgeons. A larger range of osteotomy was a suitable method to get enough operation space and reduce intraoperative risks. But osteotomy, especially facetectomy, may be associated with the biomechanical deterioration and resulting adjacent segment diseases (ASD). Hence, the objects of this study were to investigate whether different levels of surgical experience in performing different ranges of osteotomy (especially facetectomy) affected the risk for ASD and to identify the safe indications for the training of PED novice surgeons. Study Design. In this study, a three-dimensional lumbosacral model was constructed and validated. Corresponding translaminar PED models with different ranges of osteotomy for armpit, periradicular, and shoulder types of LDH were constructed. The von Mises stress on the endplates, the shear stress on the annulus, the intradiscal pressure, and the range of motion (ROM) in the L3-L4 segment disc were computed. Results. Computational results in our well-validated model indicated that large ranges of osteotomy led to deterioration in most of the biomechanical indicators, and this trend was most significant in the shoulder-type LDH model. Conclusions. To ensure the appropriateness of the surgical prognosis, armpit and periradicular types of LDH can be seen as suitable indications for the training of novice PED surgeons, and shoulder-type LDH should be excluded from such indications until novices can perform PED within a relatively small range of osteotomy. Mini Abstract. Based on biomechanical variations in our finite element analysis, armpit and periradicular types of LDH can be seen as suitable indications for the training of novice PED surgeons, and shoulder-type LDH should be excluded until novices can perform PED within a relatively small range of osteotomy.

show abstract

Section: Discussionmentioning

confidence: 99%

Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element Analysis

Wang

Jiang

et al. 2020

BioMed Research International

View full text Add to dashboard Cite

show abstract

“…Ekman et al in their study demonstrated that spinal fusion accelerates the normal degenerative changes occurring at the adjacent level 12) . Furthermore, the incidence rates of RASD and CASD after lumbar fusion surgery involving more than one segment have been reported to range from 5.2% to 100% 6) and from 1% to 36.1%, respectively 6,14,30) . In a study that included 1,250 patients, Ghasemi et al reported that the incidence of CASD was 1.04% in the 5 years after surgery and that increased BMI, preoperative ASD, and a disc bulge on MRI were risk factors for development of CASD 14) .…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the incidence rates of RASD and CASD after lumbar fusion surgery involving more than one segment have been reported to range from 5.2% to 100% 6) and from 1% to 36.1%, respectively 6,14,30) . In a study that included 1,250 patients, Ghasemi et al reported that the incidence of CASD was 1.04% in the 5 years after surgery and that increased BMI, preoperative ASD, and a disc bulge on MRI were risk factors for development of CASD 14) . Meanwhile, Ghiselli et al in their study reported that the incidence of CASD requiring additional surgery in 215 patients was 16.5% at 5 years and 36.1% at 10 years 30) .…”

Section: Discussionmentioning

confidence: 99%

“…Various risk factors for ASD after one-segment fusion have been reported, including age and sex, preoperative adjacent disc degeneration, sagittal malalignment, number of segments fused, laminar inclination, facet tropism, and excessive distraction of the disc space 6,[12][13][14][15][16][17][18][19] . However, in the present study, there was no significant association of age, sex, or preoperative disc degeneration with RASD, and the only risk factor was a preoperative absolute value of UIV tilt >10°(i.e., preoperative UIV tilt > 10°or UIV tilt < −10°).…”

Section: Discussionmentioning

confidence: 99%

“…A variety of risk factors for ASD after lumbar spine fu-sion surgery have been reported, including the length of the fusion, sagittal malalignment, age and sex, preoperative ASD, laminar inclination, facet tropism, and excessive disc distraction 6,[12][13][14][15][16][17][18][19] . It is known that the greater the number of fused segments the greater the risk of ASD.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Preoperative Risk Factors for Adjacent Segment Degeneration after Two-Level Floating Posterior Fusion at L3-L5

Ushio

Hirai

Yoshii

et al. 2020

Spine Surg Relat Res

View full text Add to dashboard Cite

Introduction: The aims of this study were to investigate how adjacent segment degeneration (ASD) occurs at the proximal and distal segments after L3-L5 fusion surgery, namely, floating fusion, and to identify the risk factors for ASD in patients who undergo this surgery. Methods: Fifty patients who underwent floating fusion surgery at vertebrae L3-L5 and developed ASD were enrolled. The following parameters were evaluated: body mass index (BMI), diabetes status, dialysis status, lumbar lordosis, segmental lordosis between the L2 upper endplate and the L3 lower endplate, disc height, Cobb's angle, apical vertebral rotation using the Nash and Moe classification method, preoperative disc degeneration, surgical procedures, and the upper instrumented vertebra (UIV) tilt angle. The UIV tilt angle was defined as positive when the anterior side was directed caudally. Results: Twenty-two (44%) of the 50 patients showed cephalad radiographic ASD (RASD) and 5 patients (10%) showed caudad RASD. Clinically symptomatic ASD was found at L2-L3 in 4 patients (8%) and at L5-S1 in 2 patients (4%). All the patients with clinically symptomatic cephalad ASD underwent revision procedures for radiculopathy or claudication because of degenerative pathology at L3-L4. Multivariate regression analysis showed a significant association of the absolute value of UIV tilt angle (mean |UIV tilt|) with cephalad RASD (odds ratio 1.09, p = 0.038). Receiver-operating characteristic curve analysis showed a significant association of |UIV tilt| >10.3°with RASD (sensitivity 67.9%, specificity 77.3%, area under the curve [AUC] 0.675). Conclusions: RASD was more likely to occur at the adjacent segment on the cephalad side than at the adjacent segment on the caudad side after two-segment floating fusion of L3-L5. A preoperative UIV tilt angle >10°or UIV tilt < −10°was a risk factor for RASD.

show abstract

Biomechanical role of osteoporosis in the vibration characteristics of human spine after lumbar interbody fusion

Guo

2020

Numer Methods Biomed Eng

View full text Add to dashboard Cite

Lumbar vertebrae osteoporosis is the most common challenge for lumbar interbody fusion, and this challenge has been widely concerned by scholars for many years. However, under whole-body vibration, osteoporosis how to affect the vibration characteristics of the fusion lumbar spine, complications, and fusion outcomes is urgent to know. The L1-L5 finite element model of lumbar spine was modified to simulate the transforaminal lumbar interbody fusion model with the bilateral pedicle screw fixator at L4-L5 level. A 5 Hz, 40 N sinusoidal vertical load supplemented with a 400 N preload was used to simulate the vertical vibration of human body. The results showed that under wholebody vibration, osteoporosis of fused vertebrae may cause the adjacent segments more unstable and increase the risk of adjacent segment diseases, subsidence, cage failure, rod failure, and lumbar instability. Osteoporosis of the fused vertebrae may cause the vertebral cells an unstable, inhibited growth and lead to poorer fusion outcomes. The findings may assist us in understanding the effect of osteoporosis on the vibration characteristics of lumbar spine fusion and provide references to clinical treatments for lumbar interbody fusion and lumbar vertebrae osteoporosis.

show abstract

Adjacent segment degeneration after posterior lumbar fusion: An analysis of possible risk factors

Cited by 35 publications

References 11 publications

Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element Analysis

Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element Analysis

Preoperative Risk Factors for Adjacent Segment Degeneration after Two-Level Floating Posterior Fusion at L3-L5

Biomechanical role of osteoporosis in the vibration characteristics of human spine after lumbar interbody fusion

Contact Info

Product

Resources

About