Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360° fusion

Schulte, Tobias L.; Leistra, Freek; Bullmann, Viola; Osada, Nani; Vieth, Volker; Marquardt, B.; Lerner, Thomas; Liljenqvist, Ulf; Hackenberg, Lars

doi:10.1007/s00586-007-0515-7

Cited by 97 publications

(67 citation statements)

References 34 publications

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“…There is an increasing concern, regarding the long-term consequences of these asymptomatic changes; however, correlation of ASD and clinical outcome is still unclear [46,52].…”

Section: Discussionmentioning

confidence: 99%

“…ASD incidence is higher in patients with transpedicular instrumentation (12.2-18.5%) compared with patients fused with other forms of instrumentation or with no instrumentation (5.2-5.6%). Evidence of radiographic degeneration, however, does not necessarily lead to a poor clinical outcome of surgery [21,52]. A recent clinical study [52] showed that the incidence of ASD (DH reduction) in the first cephalad adjacent segment 10 years following 360°i nstrumented lumbar fusion averaged 21%, while in the second adjacent level averaged 16%.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence of radiographic degeneration, however, does not necessarily lead to a poor clinical outcome of surgery [21,52]. A recent clinical study [52] showed that the incidence of ASD (DH reduction) in the first cephalad adjacent segment 10 years following 360°i nstrumented lumbar fusion averaged 21%, while in the second adjacent level averaged 16%. In our series, the incidence of ASD both in the first and second cephalad adjacent segment following posterolateral transpedicular fixation without Wallis averaged 28.6%, while in the Wallis group it was 4.1%.…”

Section: Discussionmentioning

confidence: 99%

“…However, to solve the complication of ASD several flexible or even dynamic devices have been used with controversial results [17,43,50,52]. It has been proposed that non-fusion motion preservation surgery may prevent accelerated ASD because of the protective effects of continuing segmental motion.…”

Section: Discussionmentioning

confidence: 99%

“…CT scans, MRI were made in most, but not in all cases and thus were not included in the evaluation of the ASD changes as others also quite recently did [52]. The radiographic changes were evaluated by a senior orthopaedic radiologist and spine surgeon who did not participate in surgery and thus did not know to which group each patient belong.…”

Section: Methodsmentioning

confidence: 99%

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Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

et al. 2009

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Delayed complications following lumbar spine fusion may occur amongst which is adjacent segment degeneration (ASD). Although interspinous implants have been successfully used in spinal stenosis to authors' knowledge such implants have not been previously used to reduce ASD in instrumented lumbar fusion. This prospective controlled study was designed to investigate if the implantation of an interspinous implant cephalad to short lumbar and lumbosacral instrumented fusion could eliminate the incidence of ASD and subsequently the related reoperation rate. Groups W and C enrolled initially each 25 consecutive selected patients. Group W included patients, who received the Wallis interspinous implant in the unfused vertebral segment cephalad to instrumentation and the group C selected age-, diagnosis-, level-, and instrumentationmatched to W group patients without interspinous implant (controls). The inclusion criterion for Wallis implantation was UCLA arthritic grade \II, while the exclusion criteria were previous lumbar surgery, severe osteoporosis or degeneration[UCLA grade II in the adjacent two segments cephalad to instrumentation. All patients suffered from symptomatic spinal stenosis and underwent decompression and 2-4 levels stabilization with rigid pedicle screw fixation and posterolateral fusion by a single surgeon. Lumbar lordosis, disc height (DH), segmental range of motion (ROM), and percent olisthesis in the adjacent two cephalad to instrumentation segments were measured preoperatively, and postoperatively until the final evaluation. VAS, SF-36, and Oswestry Disability Index (ODI) were used. One patient of group W developed pseudarthrosis: two patients of group C deep infection and one patient of group C ASD in the segment below instrumentation and were excluded from the final evaluation. Thus, 24 patients of group W and 21 in group C aged 65? 13 and 64? 11 years, respectively were included in the final analysis. The follow-up averaged 60 ± 6 months. The instrumented levels averaged 2.5 ? 1 vertebra for both groups. All 45 spines showed radiological fusion 8-12 months postoperatively. Lumbar lordosis did not change postoperatively. Postoperatively at the first cephalad adjacent segment: DH increased in the group W (P = 0.042); ROM significantly increased only in group C (ANOVA, P \ 0.02); olisthesis decreased both in flexion (P = 0.0024) and extension (P = 0.012) in group W. The degeneration or deterioration of already existed ASD in the two cephalad segments was shown in 1 (4.1%) and 6 (28.6%) spines in W and C groups, respectively. Physical function (SF-36) and ODI improved postoperatively (P \ 0.001), but in favour of the patients of group W (P \ 0.05) at the final evaluation. Symptomatic ASD required surgical intervention was in 3 (14%) patients of group C and none in group W. ASD remains a significant problem and accounts for a big portion of revision surgery following instrumented lumbar fusion. In this series, the Wallis interspinous implant changed the natural history of ASD and saved th...

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“…There is an increasing concern, regarding the long-term consequences of these asymptomatic changes; however, correlation of ASD and clinical outcome is still unclear [46,52].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

et al. 2009

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Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Cheung¹,

Samartzis²,

Karppinen³

et al. 2010

Arthritis & Rheumatism

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Objective. Typically, age and abnormal physical loading ("wear and tear") have been associated with the development of intervertebral disc degeneration. In the past decade, various additional etiologic factors for disc degeneration have been sporadically reported in the literature; however, many investigators continue to place tremendous emphasis on the effects of age and biomechanics associated with disc degeneration. The aim of this study was to provide additional insight into the notion that age and biomechanics are key factors in the development of disc degeneration. To this end, we addressed the prevalence of and risk factors associated with a unique pattern of disc degeneration of the lumbar spine, "skipped" level (nonconsecutive) disc degeneration (SLDD).Methods. As part of a large genetics-based study in southern Chinese individuals (n ‫؍‬ 1,989), a crosssectional analysis was performed in subjects exhibiting disc degeneration in >2 levels (n ‫؍‬ 838) who were then categorized as having SLDD (n ‫؍‬ 174) or non-SLDD (contiguous, multilevel; n ‫؍‬ 664). Various radiographic parameters were assessed based on T2-weighted magnetic resonance imaging (MRI). Subject demographics were assessed, and univariate and multivariate logistic regression analyses were performed.Results. Overall, 8.7% of the whole population (n ‫؍‬ 1,989) had SLDD, while it was present in 20.8% of subjects with multilevel disc degeneration (n ‫؍‬ 838). SLDD was more prevalent in male subjects (adjusted odds ratio [OR] 1.48, 95% confidence interval [95% CI] 1.04-2.10, P ‫؍‬ 0.028). SLDD was significantly associated with the presence of Schmorl's nodes (adjusted OR 2.72, 95% CI 1.78-4.15, P < 0.001), which also presented in levels with no disc degeneration. A history of disc bulge/extrusion (P ‫؍‬ 0.004) and/or a history of back injury (P ‫؍‬ 0.010) was significantly associated with non-SLDD, and a greater degree of overall severity of disc degeneration was also associated with non-SLDD. Other demographic and MRI findings did not significantly differ between groups.Conclusion. To our knowledge, this report is the first to describe the prevalence and risk factors associated with SLDD. Our study challenges the paradigm that age and biomechanics are the key factors associated with the development of disc degeneration. Although age and biomechanical factors may play a role in the manifestation of disc degeneration, our novel findings of SLDD patterns provide further awareness of and support for the notion that additional etiologic factors may play a role in the development of disc degeneration. Such factors warrant further investigation to shed light on the cause of disc degeneration.

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Minimally Invasive Spinous Process Fixation and Fusion

Sellin

Brusko

Wang

2019

Minimally Invasive Spine Surgery

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Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360° fusion

Cited by 97 publications

References 34 publications

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

Intervertebral disc degeneration: New insights based on “skipped” level disc pathology

Minimally Invasive Spinous Process Fixation and Fusion

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