Adjacent segment disease on hip joint as a complication of spinal fusion surgery including sacroiliac joint fixation

Kozaki, Takuhei; Hashizume, Hiroshi; Nishiyama, Daisuke; Iwasaki, Hiroshi; Tsutsui, Shunji; Takami, Masanari; Yukawa, Yasutsugu; Minamide, Akihito; Taniguchi, Takaya; Nagata, Keiji; Fukui, Daisuke; Tamai, Hidenobu; Taiji, Ryo; Murata, Shizumasa; Oka, Hiroyuki; Yamada, Hiroshi

doi:10.1007/s00586-020-06700-4

Cited by 20 publications

(27 citation statements)

References 21 publications

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“…[13][14][15][16] To the knowledge of the authors, this is the first published series of cervical sagittal alignment measurements in the setting of PJF manifesting as an odontoid fracture. 17 Analogous to our growing understanding of the distal consequences of fusion, namely sacroiliac joint and hip dysfunction, [18][19][20] this study highlights the potential for proximal consequences.…”

Section: Discussionmentioning

confidence: 69%

Odontoid Fracture as Proximal Junctional Failure in Patients With Multilevel Spine Fusions

Ladd

Martin

Sembrano

et al. 2021

Global Spine Journal

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Study Design: Retrospective study. Objective: Proximal junctional failure (PJF) commonly occurs as a recognized potential outcome of fusion surgery. Here we describe a unique series of patients with multilevel spine fusion including the cervical spine, who developed PJF as an odontoid fracture. Methods: We performed a single site retrospective review of patients with prior fusion that included a cervical component, who presented with an odontoid fracture between 2012 and 2019. Radiographic measurements included C2-C7 SVA, C2-C7 lordosis, T1 slope, Occiput-C2 angle, proximal junctional kyphosis, and cervical mismatch. Associated fractures, medical comorbidities, and treatments were determined via chart review after IRB approval. Results: Nine patients met inclusion criteria. 5 reported trauma with subsequent onset of pain. All patients sustained a Type II odontoid fracture. 5 with associated C1/Jefferson fractures. In all patients, pre-injury Occiput-C2 angle was outside normative range; C2-C7 SVA was greater than 4 cm in 6 patients; T1-slope minus cervical lordosis was greater than 18.5 degrees in 6 patients. 7 patients were treated operatively with extension of fusion to C1 and 2 patients declined operative treatment. Conclusion: In this series of 9 patients with multilevel fusion with type II odontoid fractures, all patients demonstrated abnormal pre-fracture sagittal alignment parameters and a greater than normal association of C1 fractures was noted. Further study is needed to establish the role of poor sagittal alignment with compensatory occiput-C2 angulation as a predisposing factor for odontoid fracture as a proximal junctional failure mechanism.

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Section: Discussionmentioning

confidence: 69%

Odontoid Fracture as Proximal Junctional Failure in Patients With Multilevel Spine Fusions

Ladd

Martin

Sembrano

et al. 2021

Global Spine Journal

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“…A previous study reported that spinal fusion surgery added stress to the adjacent spinal segment and sacroiliac joint 9,18) . Adult spinal deformity surgery, including sacroiliac joint fixation, has also been shown to influence the hip joint in a radiographical study 8) . Our results support these previous findings and suggest that adult spinal fusion surgery, including S2 alar iliac screw fixation, may contribute to osteoarthritis of the hip joint.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, hip joint pain after spinal fusion surgery has been reported 5) . A radiological study reported that sacroiliac joint fixation in adult spinal fusion surgery decreased the amount of cartilage in the hip joint 8) . In our FE study, it was clear that lumbosacral fusion led to a greater increase in the angular motion and stress on the sacroiliac joint than lumbar fusion, which does not include pelvic fixation.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, sacroiliac screws are used to prevent distal junctional failure in adult spinal deformity surgery 6,7) . A radiographic study showed that sacroiliac joint fixation using a sacroiliac joint screw impacted the hip joint after adult spinal deformity surgery in 118 patients based on an X-ray study 8) . Adjacent segment disease (ASD) has also been reported as one of the major complications of spinal fusion surgery.…”

Section: Introductionmentioning

confidence: 99%

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Lumbar Fusion including Sacroiliac Joint Fixation Increases the Stress and Angular Motion at the Hip Joint: A Finite Element Study

Kozaki

Hashizume

Oka

et al. 2022

Spine Surg Relat Res

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Introduction: Adult spinal fusion surgery improves lumbar alignment and patient satisfaction. Adult spinal deformity surgery improves saggital balance not only lumbar lesion, but also at hip joint coverage. It was expected that hip joint coverage rate was improved and joint stress decreased. However, it was reported that adjacent joint disease at hip joint was induced by adult spinal fusion surgery including sacroiliac joint fixation on an X-ray study. The mechanism is still unclear. We aimed to investigate the association between lumbosacral fusion including sacroiliac joint fixation and contact stress of the hip joint.Methods: A 40-year-old woman with intact lumbar vertebrae underwent computed tomography. A three-dimensional nonlinear finite element model was constructed from the L4 vertebra to the femoral bone with triangular shell elements (thickness, 2 mm; size, 3 mm) for the cortical bone's outer surface and 2-mm (lumbar spine) or 3-mm (femoral bone) tetrahedral solid elements for the remaining bone. We constructed the following four models: a non-fusion model (NF), a L4-5 fusion model (L5F), a L4-S1 fusion model (S1F), and a L4-S2 alar iliac screw fixation model (S2F). A compressive load of 400 N was applied vertically to the L4 vertebra and a 10-Nm bending moment was additionally applied to the L4 vertebra to stimulate flexion, extension, left lateral bending, and axial rotation. Each model's hip joint's von Mises stress and angular motion were analyzed.Results: The hip joint's angular motion in NF, L5F, S1F, and S2F gradually increased; the S2F model presented the greatest angular motion.Conclusions: The average and maximum contact stress of the hip joint was the highest in the S2F model. Thus, lumbosacral fusion surgery with sacroiliac joint fixation placed added stress on the hip joint. We propose that this was a consequence of adjacent joint spinopelvic fixation. Lumbar-to-pelvic fixation increases the angular motion and stress at the hip joint.

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“…Spinal fusion surgery is often combined with pelvic fixation to prevent distal junctional kyphosis and failure [ 2 ]. The inclusion of spinopelvic fixation has been reported to induce the progression of hip joint arthropathy in a one-year radiographic follow-up study of 118 patients with ASD [ 3 ]. The causative pathology was considered as adjacent joint disease (AJD) after spinopelvic fixation surgery [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Spinopelvic fusion surgery from lower thoracic spine to pelvis increased hip joint moment–motion analysis

et al. 2022

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Purpose Spinal fusion surgery is often performed with pelvic fixation to prevent distal junctional kyphosis. The inclusion of spinopelvic fixation has been reported to induce progression of hip joint arthropathy in a radiographic follow-up study. However, its biomechanical mechanism has not yet been elucidated. This study aimed to compare the changes in hip joint moment before and after spinal fusion surgery. Methods This study was an observational study and included nine patients (eight women and one man) who were scheduled to undergo spinopelvic fusion surgery. We calculated the three-dimensional external joint moments of the hip during gait, standing, and climbing stairs before and 1 year after surgery. Results During gait, the maximum extension moment was 0.51 ± 0.29 and 0.63 ± 0.40 before and after spinopelvic fusion surgery ( p = 0.011), and maximum abduction moment was 0.60 ± 0.33 and 0.83 ± 0.34 before and after surgery ( p = 0.004), respectively. During standing, maximum extension moment was 0.76 ± 0.32 and 1.04 ± 0.21 before and after spinopelvic fusion surgery ( p = 0.0026), and maximum abduction moment was 0.12 ± 0.20 and 0.36 ± 0.22 before and after surgery ( p = 0.0005), respectively. During climbing stairs, maximum extension moment was − 0.31 ± 0.30 and − 0.48 ± 0.15 before and after spinopelvic fusion surgery ( p = 0.040), and maximum abduction moment was 0.023 ± 0.18 and − 0.02 ± 0.13 before and after surgery ( p = 0.038), respectively. Conclusion This study revealed that hip joint flexion–extension and abduction–adduction moments increased after spinopelvic fixation surgery in the postures of standing, walking, and climbing stairs. The mechanism was considered to be adjacent joint disease after spinopelvic fusion surgery including sacroiliac joint fixation.

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Adjacent segment disease on hip joint as a complication of spinal fusion surgery including sacroiliac joint fixation

Cited by 20 publications

References 21 publications

Odontoid Fracture as Proximal Junctional Failure in Patients With Multilevel Spine Fusions

Odontoid Fracture as Proximal Junctional Failure in Patients With Multilevel Spine Fusions

Lumbar Fusion including Sacroiliac Joint Fixation Increases the Stress and Angular Motion at the Hip Joint: A Finite Element Study

Spinopelvic fusion surgery from lower thoracic spine to pelvis increased hip joint moment–motion analysis

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