Does Superior-Segment Facet Violation or Laminectomy Destabilize the Adjacent Level in Lumbar Transpedicular Fixation?

Cardoso, Mario J.; Dmitriev, Anton E.; Helgeson, Melvin D.; Lehman, Ronald A.; Kuklo, Timothy R.; Rosner, Michael

doi:10.1097/brs.0b013e31818c63d3

Cited by 106 publications

(77 citation statements)

References 24 publications

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“…The exact aetiology is uncertain but alterations in facet loading, hypermobility, and increased intradiscal pressure at the segments adjacent to fusion mass is believed to play a key role [15,21,35,44,51,60]. Superior segment facet violation or laminectomy has recently shown in vitro to destabilize the adjacent level in transpedicular fixation [9].…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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“…Total lumbar disc replacement Fusion of lumbar motion segments has been associated with a variety of early and late complications in a considerable number of patients [1][2][3][4][5][6][7][8][9][10][11][12]. In an attempt to avoid these fusion-related negative side effects, motion preserving technologies such as total lumbar disc replacement (TDR) procedures have been introduced.…”

Section: Ddd Versus Preoperative Clinical Symptomatologymentioning

confidence: 99%

Influence of lumbar intervertebral disc degeneration on the outcome of total lumbar disc replacement: a prospective clinical, histological, X-ray and MRI investigation

Siepe¹,

Heider²,

Haas

et al. 2012

Eur Spine J

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“…PLIF with CBT screw fixation might reduce the incidence of symptomatic ASD due to limiting the dissection of the superior facet joints, reducing muscle dissection and retraction, and possibly reducing the risk of superior facet violation, which reportedly can increase biomechanical stress and lead to destabilization at the supradjacent segment. 2,4 The authors speculate that these merits of CBT screw fixation could lead to a significantly lower incidence of symptomatic ASD in the CBT group than in the PS group, although the postoperative follow-up period in the 2 groups was relatively short (the mean follow-up period was less than 5 years) and a further long-term follow-up study would thus be needed to verify a more accurate incidence of symptomatic ASD in the 2 groups.…”

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confidence: 99%

Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis: a comparative study

Sakaura

Miwa

Yamashita

et al. 2016

SPI

103

102

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OBJECTIVE Several biomechanical studies have demonstrated the favorable mechanical properties of the cortical bone trajectory (CBT) screw. However, no reports have examined surgical outcomes of posterior lumbar interbody fusion (PLIF) with CBT screw fixation for degenerative spondylolisthesis (DS) compared with those after PLIF using traditional pedicle screw (PS) fixation. The purposes of this study were thus to elucidate surgical outcomes after PLIF with CBT screw fixation for DS and to compare these results with those after PLIF using traditional PS fixation. METHODS Ninety-five consecutive patients underwent PLIF with CBT screw fixation for DS (CBT group; mean followup 35 months). A historical control group consisted of 82 consecutive patients who underwent PLIF with traditional PS fixation (PS group; mean follow-up 40 months). Clinical status was assessed using the Japanese Orthopaedic Association (JOA) scale score. Fusion status was assessed by dynamic plain radiographs and CT. The need for additional surgery and surgery-related complications was also evaluated. RESULTS The mean JOA score improved significantly from 13.7 points before surgery to 23.3 points at the latest follow-up in the CBT group (mean recovery rate 64.4%), compared with 14.4 points preoperatively to 22.7 points at final follow-up in the PS group (mean recovery rate 55.8%; p < 0.05). Solid spinal fusion was achieved in 84 patients from the CBT group (88.4%) and in 79 patients from the PS group (96.3%, p > 0.05). Symptomatic adjacent-segment disease developed in 3 patients from the CBT group (3.2%) compared with 9 patients from the PS group (11.0%, p < 0.05). CONCLUSIONS PLIF with CBT screw fixation for DS provided comparable improvement of clinical symptoms with PLIF using traditional PS fixation. However, the successful fusion rate tended to be lower in the CBT group than in the PS group, although the difference was not statistically significant between the 2 groups.

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Does Superior-Segment Facet Violation or Laminectomy Destabilize the Adjacent Level in Lumbar Transpedicular Fixation?

Cited by 106 publications

References 24 publications

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

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

Influence of lumbar intervertebral disc degeneration on the outcome of total lumbar disc replacement: a prospective clinical, histological, X-ray and MRI investigation

Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis: a comparative study

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