Demographic, clinical, and operative risk factors associated with postoperative adjacent segment disease in patients undergoing lumbar spine fusions: a systematic review and meta-analysis

Mesregah, Mohamed Kamal; Yoshida, Brandon; Lashkari, Nassim; Abedi, Aidin; Meisel, Hans-Joerg; Diwan, Ashish D.; Hsieh, Patrick C.; Wang, Jeffrey C.; Buser, Zorica; Yoon, S. Tim

doi:10.1016/j.spinee.2021.12.002

Cited by 27 publications

(29 citation statements)

References 56 publications

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“…In line with the previous reports, potential risk factors for ASD development we have selected and evaluated, including age, gender, smoking history, diabetes mellitus, hypertension, BMI, BMD, operation time, postoperative blood loss, preoperative adjacent disc degeneration, preoperative adjacent disc height, etc. [ 13 , 14 ]. The T score obtained from the lumbar Dual Energy X-ray Absortiometry (DEXA, GE Lunar; Prodigy, Madison, WI) scans were used to assess the association between preoperative overall fracture risk and BMD before surgery.…”

Section: Methodsmentioning

confidence: 99%

Adjacent segment disease after minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar diseases: incidence and risk factors

Yuan

Zhou

Wang

et al. 2022

BMC Musculoskelet Disord

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Study design Retrospective study. Objectives To explore the incidence and risk factors for symptomatic adjacent segment disease (ASD) in patients enveloped in degenerative lumbar diseases after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods Data were retrospectively analyzed on 744 patients who underwent MIS-TLIF for degenerative lumbar diseases in our hospital from October 2012 to December 2018. The patients were divided into the ASD group and non-ASD (N-ASD) group on the basis of developing ASD at follow-up, and then the incidence of ASD was calculated. Clinical and radiological risk factors were assessed over time to determine their association with ASD by excluding less important factors. Results Data were missing for 26 patients, while a total of 718 patients were successfully monitored after MIS-TLIF. Of the 718 individuals participated in the study, 34 (4.7%) patients plagued by ASD required surgical intervention. The average onset time of ASD was 62.7 ± 15.1 months. Univariate analysis results shows that age, bone mineral density (BMD), body mass index (BMI), preoperative adjacent intervertebral disc height and preoperative adjacent segment disc degeneration were significantly different between the ASD and N-ASD groups (p < 0.05). The logistic regression analysis results demonstrated that BMD (p = 0.039, OR = 0.986, 95% CI 0.899–1.115), BMI (p = 0.041, OR = 1.119, 95% CI 1.103–2.397), and preoperative adjacent intervertebral disc degeneration (p = 0.023, OR = 1.215, 95% CI 1.015–1.986) may be seen as risk factors for ASD after MIS-TLIF. Conclusions The incidence of ASD was about 4.7% in patients suffer from degenerative lumbar diseases after MIS-TLIF. BMD, BMI and preoperative adjacent intervertebral disc degeneration might be the risk factors for the occurrence of ASD after MIS-TLIF. Our research also suggested that patients with lower BMD, higher BMI and disc preoperative adjacent segment disc degeneration were more likely to develop ASD after MIS-TLIF.

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Section: Methodsmentioning

confidence: 99%

Adjacent segment disease after minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar diseases: incidence and risk factors

Yuan

Zhou

Wang

et al. 2022

BMC Musculoskelet Disord

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“…Zusätzlich zu den genannten Aspekten sind operationsbedingte und somit beeinflussbare Risikofaktoren zu nennen. Zu diesen zählen multisegmentale Fusionen, Dekompressionen außerhalb der fusionierten Segmente, sowie auch die Entfernung der Lamina oder eine Beschädigung der Facettengelenke des Anschlusswirbels [8,14,16,25]. Ein weiterer Risikofaktor für das Auftreten einer ASD sind lumbale Fusionen, die auf Höhe des 5.…”

Section: Risikofaktorenunclassified

Vermeidung von Anschlussdegenerationen nach operativer Therapie lumbaler, degenerativer Wirbelsäulenpathologien

2022

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Adjacent segment degeneration (ASD) is a common complication after spine surgery and often requires surgical revision. Given its importance and the multifactorial development, numerous articles on etiology, treatment options and prevention have been published. Prior to surgery, patient-related risk factors such as BMI, age, spinal anatomy and alignment need to be part of the decision-making process. The type and extent of surgery contribute to the development of ASD as well as the damage of dorsal anatomical structures such as facet joints and the paraspinal musculature. Current literature does not justify the use of motion-preserving procedures to diminish ASD occurrence. Importantly, it is recommended to act with regard to the individual spinopelvic alignment and limit the invasiveness of the given surgical procedure in order to prevent ASD. Nevertheless, despite significant research efforts, ASD remains a complication that has not yet been adequately addressed.

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“…Adjacent segment disease (ASD) is defined as a degenerative disorder occurring in the cranial or caudal vertebral body at the lumbar fusion segment, which constitutes one of the most salient complications after posterior lumbar fusion 1 . ASD is considered any abnormal process that develops in the mobile segment next to spinal fusion, accompanied by related symptoms, such as radiculopathy, myelopathy, instability and so on 2,3 . Changed biomechanics near the previous fusion site predispose to degenerative changes, and the existing spondylosis at adjacent levels are associated with the occurrence of ASD 4–7 .…”

Section: Introductionmentioning

confidence: 99%

“… 1 ASD is considered any abnormal process that develops in the mobile segment next to spinal fusion, accompanied by related symptoms, such as radiculopathy, myelopathy, instability and so on. 2 , 3 Changed biomechanics near the previous fusion site predispose to degenerative changes, and the existing spondylosis at adjacent levels are associated with the occurrence of ASD. 4 , 5 , 6 , 7 Clinically, ASD is primarily manifested as unilateral disc herniation, which leads to lower extremity nerve root pain and seriously affects the quality of life of patients.…”

Section: Introductionmentioning

confidence: 99%

Application of Oblique Lateral Interbody Fusion Combined with Bridge‐Locking Cage in Adjacent Segment Disease After Lumbar Fusion

Zhang

Yin

2022

Orthopaedic Surgery

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Objective: Adjacent segment disease (ASD) is considered any abnormal process that develops in the mobile segment next to spinal fusion, accompanied by related symptoms. To evaluate the efficacy and complications of oblique lateral interbody fusion (OLIF) combined with bridge-locking fusion on ASD after lumbar fusion.Methods: A total of 35 ASD patients who required re-operation after lumbar fusion in our hospital from March 2014 to March 2020 were retrospectively analyzed, among which 13 cases (seven males and six females; 62.3 AE 11.3 years old) received the treatment of OLIF + bridge-locking cage internal fixation (OLIF group), and 22 cases (14 males and eight females; 52.3 AE 17.8 years old) received the treatment of transforaminal lumbar interbody fusion (TLIF) + pedicle screw fixation (TLIF group). The comparison of the operation time, intraoperative blood loss, postoperative drainage volume, and length of hospital stay between the two groups of patients was performed using the t-test. The comparison of Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at different time points before and after the operation was performed using analysis of variance for repeated measurement data. The fusion rate and postoperative complications of the two groups of patients were also evaluated. Results:The operation time of patients in the OLIF group (55.4 AE 12.4 min) was significantly shorter than that of patients in the TLIF group (94.3 AE 22.9 min) (P < 0.05), the length of stay of patients in the OLIF group (7.4 AE 2.3 day) was significantly shorter than that of patients in the TLIF group (12.4 AE 3.2 day) (P < 0.05); the intraoperative blood loss (62.2 AE 30.1 mL) and postoperative drainage (47.3 AE 22.4 mL) of patients in the OLIF group were significantly less than those of patients in the TLIF group with intraoperative blood loss (363.4 AE 120.2 mL) and postoperative drainage (285.5 AE 57.8 mL) (all Ps < 0.05). Besides, the VAS and ODI scores of the two groups of patients were improved 3 months after the operation and at the last follow-up (all Ps < 0.05). Three patients in the OLIF group developed complications such as hip flexion weakness and fusion cage sink, with an incidence of 23.1%. Three patients in the TLIF group developed complications including wound infection and intraoperative nerve injury, with an incidence of 22.7%. Conclusion:The combination of OLIF and bridge-locking cage may be a safe and effective therapy for ASD patients after lumbar fusion operation.

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Demographic, clinical, and operative risk factors associated with postoperative adjacent segment disease in patients undergoing lumbar spine fusions: a systematic review and meta-analysis

Cited by 27 publications

References 56 publications

Adjacent segment disease after minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar diseases: incidence and risk factors

Adjacent segment disease after minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar diseases: incidence and risk factors

Vermeidung von Anschlussdegenerationen nach operativer Therapie lumbaler, degenerativer Wirbelsäulenpathologien

Application of Oblique Lateral Interbody Fusion Combined with Bridge‐Locking Cage in Adjacent Segment Disease After Lumbar Fusion

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