Adjacent Segment Motion After a Simulated Lumbar Fusion in Different Sagittal Alignments

Akamaru, Tomoyuki; Kawahara, Norio; Yoon, S. Tim; Minamide, Akihito; Kh, Kim; Tomita, Katsuro; Hutton, William

doi:10.1097/01.brs.0000076820.44132.99

Cited by 129 publications

(82 citation statements)

References 21 publications

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“…Previous studies have revealed the facet and iliosacral joints to be a source of post-operative pain in a considerable number of patients [29,42,43]. Alterations of the segmental, sagittal and spinopelvic alignment as well as increased motion and stress adjacent to fused levels have been held responsible for post-fusion pain patterns [1,21,29,32,42,43,63].…”

Section: Discussionmentioning

confidence: 99%

“…These post-operative pain patterns have been linked to increased stress distribution and motion adjacent to the fused segments as well as to pathologically altered lumbar segmental, sagittal and spinopelvic alignment [1,21,29,32,35,42,43,63]. The reported incidence of symptomatic ''fusion-related'' pain patterns from posterior joint structures ranges from 32 to 61%, and it's clinical relevance has been confirmed in a variety of studies using fluoroscopically guided spine infiltrations [29,42,43].…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Siepe¹,

Korge²,

Grochulla³

et al. 2007

Eur Spine J

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Although a variety of biomechanical laboratory investigations and radiological studies have highlighted the potential problems associated with total lumbar disc replacement (TDR), no previous study has performed a systematic clinical failure analysis. The aim of this study was to identify the post-operative pain sources, establish the incidence of post-operative pain patterns and investigate the effect on post-operative outcome with the help of fluoroscopically guided spine infiltrations in patients from an ongoing prospective study with ProDisc II. Patients who reported unsatisfactory results at any of the FU-examinations received fluoroscopically guided spine infiltrations as part of a semi-invasive diagnostic and conservative treatment program. Pain sources were identified in patients with reproducible (C29) significant (50-75%) or highly significant (75-100%) pain relief. Results were correlated with outcome parameters visual analogue scale (VAS), Oswestry disability index (ODI) and the subjective patient satisfaction rate. From a total of 175 operated patients with a mean follow-up (FU) of 29.3 months (range 12.2-74.9 months), n = 342 infiltrations were performed in n = 58 patients (33.1%) overall. Facet joint pain, predominantly at the index level (86.4%), was identified in n = 22 patients (12.6%). The sacroiliac joint was a similarly frequent cause of post-operative pain (n = 21, 12.0%). Pain from both structures influenced all outcome parameters negatively (P \ 0.05). Patients with an early onset of pain (B6 months) were 2-59 higher at risk of developing persisting complaints and unsatisfactory outcome at later FU-stages in comparison to the entire study cohort (P \ 0.05). The level of TDR significantly influenced postoperative outcome. Best results were achieved for the TDRs above the lumbosacral junction at L4/5 (incidence of posterior joint pain 14.8%). Inferior outcome and a significantly higher incidence of posterior joint pain were observed for TDR at L5/S1 (21.6%) and bisegmental TDR at L4/5/S1 (33.3%), respectively. Lumbar facet and/or ISJpain are a frequent and currently underestimated source of post-operative pain and the most common reasons for unsatisfactory results following TDR. Further failureanalysis studies are required and adequate salvage treatment options need to be established with respect to the underlying pathology of post-operative pain. The question as to whether or not TDR will reduce the incidence of posterior joint pain, which has been previously attributed to lumbar fusion procedures, remains unanswered. Additional studies will have to investigate whether TDR compromises the index-segment in an attempt to avoid adjacent segment degeneration.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Siepe¹,

Korge²,

Grochulla³

et al. 2007

Eur Spine J

View full text Add to dashboard Cite

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“…In high-grade spondylolisthesis, the technique is prone to a significant rate of non-union or subsequent slip progression. For both low-and high-grade spondylolisthesis, in situ fusion runs contrary to the principle of restoring physiological alignment and balance and may have longterm implications on adjacent segment disease [1].…”

Section: Introductionmentioning

confidence: 99%

“In situ” fusion or reduction in high-grade high dysplastic developmental spondylolisthesis (HDSS)

2012

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Purpose To assess if the evaluation of the spino-pelvic balance can be effective in the surgical decision making of the high-grade high dysplastic developmental spondylolisthesis (HDDS). Methods Sixteen patients affected with high-grade HDDS (6 treated with ''in situ'' fusion, and 10 with reduction and fusion) were retrospectively evaluated. A clinical and radiological assessment of the deformity correction was carried out, with a minimum follow-up of 2 years. The differences between the pre-and postoperative measures were statistically analyzed using a two-tailed, paired t test. Results The six patients treated with ''in situ'' fusion showed no statistically significant change at the last followup relative to pelvic tilt (PT), sacral slope (SS), and grade, while the 10 patients treated with reduction showed significant changes: PT significantly decreased following surgery, while SS and grade significantly increased. Conclusions The analysis of the spino-pelvic sagittal balance allows to identify two types of HDDS: the balanced deformities, which do not need reduction, and the unbalanced deformities, in which correction is needed.

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“…28) Sagittal balance is believed to be responsible for the long-term outcome of patients undergoing fusion procedures, especially with regard to ASD. 1,28) Hypolordotic alignment at L4-L5 causes the greatest amount of flexion-extension motion at L3-L4, and the differences are statistically significant compared with in situ or hyperlordotic fixation. 1) Hypolordosis in the instrumented segments causes increased load on the posterior column of the adjacent segments, which might explain the degenerative changes at the junctional level that have been observed as long-term consequences of lumbar fusion.…”

Section: Discussionmentioning

confidence: 99%

Two-Level Anterior Lumbar Interbody Fusion With Percutaneous Pedicle Screw Fixation: A Minimum 3-Year Follow-up Study

Lee

Maeng

2010

Neurol. Med. Chir.(Tokyo)

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The clinical and radiological outcomes of two-level anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PSF) were evaluated in 24 consecutive patients who underwent twolevel ALIF with percutaneous PSF for segmental instability and were followed up for more than 3 years. Clinical outcomes were assessed using a visual analogue scale (VAS) score and the Oswestry Disability Index (ODI). Sagittal alignment, bone union, and adjacent segment degeneration (ASD) were assessed using radiography and magnetic resonance imaging. The mean age of the patients at the time of operation was 56.3 years (range 39-70 years). Minor complications occurred in 2 patients in the perioperative period. At a mean follow-up duration of 39.4 months (range 36-42 months), VAS scores for back pain and leg pain, and ODI score decreased significantly (from 6.5, 6.8, and 46.9% to 3.0, 1.9, and 16.3%, respectively). Clinical success was achieved in 22 of the 24 patients. The mean segmental lordosis, whole lumbar lordosis, and sacral tilt significantly increased after surgery (from 25.19 , 39.29 , and 32.69to 32.99 , 44.59 , and 36.69 , respectively). Solid fusion was achieved in 21 patients. ASD was found in 8 of the 24 patients. No patient underwent revision surgery due to nonunion or ASD. Two-level ALIF with percutaneous PSF yielded satisfactory clinical and radiological outcomes and could be a useful alternative to posterior fusion surgery.

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Adjacent Segment Motion After a Simulated Lumbar Fusion in Different Sagittal Alignments

Cited by 129 publications

References 21 publications

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

Analysis of post-operative pain patterns following total lumbar disc replacement: results from fluoroscopically guided spine infiltrations

“In situ” fusion or reduction in high-grade high dysplastic developmental spondylolisthesis (HDSS)

Two-Level Anterior Lumbar Interbody Fusion With Percutaneous Pedicle Screw Fixation: A Minimum 3-Year Follow-up Study

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