Lumbar adjacent segment degeneration after spinal fusion surgery: a systematic review and meta-analysis

Cannizzaro, Delia; Anania, Carla Daniela; Safa, Adrian; Zaed, Ismail; Morenghi, Manuela; Riva, Marco; Tomei, Massimo; Pessina, Federico; Servadei, Franco; Ortolina, Alessandro; Fornari, Maurizio

doi:10.23736/s0390-5616.22.05891-x

Cited by 4 publications

(6 citation statements)

References 43 publications

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“…Interestingly, obesity was found in both patients with BMI of 28.5 and 28.3 kg/m 2 , as well as sever osteoporosis with BMD of -2.6 and − 2.5 (T value). Our results were consistent with Cannizzaro et al's study 22 which reported that obesity were relevant risk factors for developing lumbar adjacent segment degeneration, indicating that SRT through Wiltse approach was recommended in obese patients.…”

Section: Reduction Of Asd With Srt Through Wiltsesupporting

confidence: 92%

“…The incidence of ASD in our study was 3.12%, whch was signi cantly lower than it reported in previous study 22,23 , which might be contributed the protection of superior facet joint, facet joint capsule, and paraspinal muscles in both SRT technique and Wiltse approach. Therefore, the application of SRT through Wiltse approach as a noval surgical method, is recommended in TLIF surgery to reduce the occurrence of ASD.…”

Section: Reduction Of Asd With Srt Through Wiltsecontrasting

confidence: 72%

“…Adjacent segment degeneration (ASD) is most recognized long-term complications of lumbar surgery for degenerative spine pathologies with a relevant impact in spine surgical and clinical practice 22 . It has been veri ed that several factors are associated with ASD.…”

Section: Reduction Of Asd With Srt Through Wiltsementioning

confidence: 99%

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Clinical outcomes of Short Rod Technique in transforaminal lumbar interbody fusion surgery through Wiltse approach: A case series report

Pu,

Chen,

Tan

et al. 2024

Preprint

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Objective We present for the first time a novel entry point of pedicle screws (Short Rod Technique, SRT), which can avoid superior facet violation and has been verified as a safe screw placement method. The objective of this study is to report the clinical outcomes of SRT in transforaminal lumbar interbody fusion (TLIF) surgery through Wiltse approach. Methods We retrospectively analyzed the clinical outcomes of 64 patients who received SRT through Wiltse approach with a minimum of 2 years of follow-ups. Demographics, clinical outcomes and radiological parapmeters were recorded and analyzed. Results Less total postoperative drainage volume before removall (27.88 ± 10.27), shorter days of removal of drainage (1.08 ± 0.27) was observed in SRT through Wiltse approach. In addition, patients felt less wound pain after the surgery, improving their HRQOL. Upper adjacent segment degeneration (ASD) was found in 2 petients at final follow-up, and they also received revision surgery. Both back pain, leg pain and ODI improved after the surgery; however, due to the ASD patients, the mean value of leg pain and ODI were greater at final follow-up than they’re at post-operation. Less change of LL was observed at final follow-up than it at post-operation with significant difference. Compared with increase of SS at post-operation, SS decreased at final follow-up with significant difference of change of SS. PT decreased at post-operation, while it was found to be increased at final follow-up. PI remained constant before and after the surgery with no significant difference of change of PI. Sagittal alignment also tended to be imbalanced with the change of SVA signficantly greater at final follow-up than it at post-operation. In addition, due to the two cases of ASD, the loss of disc hight and change of slippage distance of upper adjacent segment were signficantly greater at final follow-up than they’re at post-operation. More degeneration of intervertebral disc was also observed at final follow-up. Conclusion Application of SRT through Wiltse approach in TLIF surgery has been validated as an effective technique with good clinical outcomes, especially for reducing the blood loss and postoperative wound pain and improving patients’ HRQOL. The present study provides spinal surgeons with a novel method for performing TLIF surgery.

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Section: Reduction Of Asd With Srt Through Wiltsesupporting

confidence: 92%

Section: Reduction Of Asd With Srt Through Wiltsecontrasting

confidence: 72%

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Clinical outcomes of Short Rod Technique in transforaminal lumbar interbody fusion surgery through Wiltse approach: A case series report

Pu,

Chen,

Tan

et al. 2024

Preprint

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“…25 It is still unclear how to prevent the development of clinical and radiological ASD. 5,6,26 Our study recorded a rate of 5.4% of reinterventions for ASD. One of the risk factors most associated with the onset of ASD is the age of the patient at the time of surgery.…”

Section: Transforaminal Lumbar Interbody Fusion [Tlif] Lateral Lumbar...mentioning

confidence: 69%

The lumbar adjacent-level syndrome: analysis of clinical, radiological, and surgical parameters in a large single-center series

Cannizzaro,

Anania,

De Robertis

et al. 2023

Journal of Neurosurgery: Spine

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OBJECTIVE The development of specific clinical and neurological symptoms and radiological degeneration affecting the segment adjacent to a spinal arthrodesis comprise the framework of adjacent-level syndrome. Through the analysis of a large surgical series, this study aimed to identify possible demographic, clinical, radiological, and surgical risk factors involved in the development of adjacent-level syndrome. METHODS A single-center retrospective analysis of adult patients undergoing lumbar fusion procedures between January 2014 and December 2018 was performed. Clinical, demographic, radiological, and surgical data were collected. Patients who underwent surgery for adjacent-segment disease (ASD) were classified as the ASD group. All patients were evaluated 1 month after the surgical procedure clinically and radiologically (with lumbar radiographs) and 3 months afterward with CT scans. The last follow-up was performed by telephone interview. The median follow-up for patients included in the analysis was 67.2 months (range 39–98 months). RESULTS A total of 902 patients were included in this study. Forty-nine (5.4%) patients required reoperation for ASD. A significantly higher BMI value was observed in the ASD group (p < 0.001). Microdiscectomy and microdecompression procedures performed at the upper or lower level of an arthrodesis without fusion extension have a statistically significant impact on the development of ASD (p = 0.001). Postoperative pelvic tilt in the ASD group was higher than in the non-ASD group. Numeric rating scale, Core Outcome Measures Index, and Oswestry Disability Index scores at the last follow-up were significantly higher in patients in the ASD group and in patients younger than 65 years. CONCLUSIONS Identifying risk factors for the development of adjacent-level syndrome allows the implementation of a prevention strategy in patients undergoing lumbar arthrodesis surgery. Age older than 65 years, high BMI, preexisting disc degeneration at the adjacent level, and high postoperative pelvic tilt are the most relevant factors. In addition, patients older than 65 years achieve higher levels of clinical improvement and postsurgical satisfaction than do younger patients.

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“…Currently, OLIF has demonstrated unique advantages in the treatment of conditions such as discogenic low back pain, lumbar instability, adjacent segment disease, lumbar infection, and revision surgery. ASD (Adjacent Segment Disease) after lumbar fusion surgery is an important factor affecting patient prognosis, and its incidence and revision rate should not be overlooked [11] . The etiology of ASD is complex, and although some researchers believe that its occurrence is a natural degenerative process, numerous studies focusing on surgeries like TLIF and PLIF have indicated that ASD may be associated with factors such as adjacent facet joint degeneration, adjacent disc degeneration, sagittal imbalance, osteoporosis, smoking history, hypertension, facet joint invasion, and lumbar lordosis angle [12,13] .…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Adjacent Segment Disease Following Oblique Lateral Interbody Fusion：A retrospective study

Chen

Jian-dong

Fan

et al. 2023

Preprint

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Objective: To retrospectively analyze the characteristics and related factors of adjacent segmental disease (ASD) after oblique lumbar interbody fusion (OLIF). Methods: This was a retrospective study of the effect of single- or multiple-segment OLIF combined with Wiltse-approach pedicle screw fixation on adjacent segment. For single-segment (n=92), the preoperative and last follow-up measurements of lumbar lordosis angle (LL), disc degeneration grade(DD), disc height (DH), facet joint degeneration grade (FD), and segmental angle (SA) of adjacent segments were recorded and analyzed statistically. For multiple-segment (n=56), based on the presence of ASD at the final follow-up, they were divided into the ASD group (n = 10) and non-ASD (NASD) group (n = 46). Smoking, hypertension, diabetes, osteoporosis, body mass index (BMI), and preoperative radiological parameters, including DD, FD, DH, and SA of both cranial and caudal adjacent segments, LL, and invasion of the facet joint by pedicle screws were recorded and statistically analyzed in both groups. Results: For single-segment, there was no ASD occurred during the follow-up period. There was a statistically significant difference in the lumbar lordosis angle between preoperative and last follow-up measurements (t=8.2860, P<0.0001), but no statistical difference in the DD, DH, FD, or SA of caudal and cranial segments. For multiple-segment, ASD occurred only in the caudal segment, specifically L5/S1 segment. For the comparison of ASD and NASD, there were statistically significant differences in the preoperative caudal adjacent DD (χ2=12.2500, P=0.0156*) and DH (t=3.6430, P=0.0004*) , age (t=2.1090, P=0.0396), and proportion of patients with osteoporosis (χ2=12.7800, P=0.0003*), but no statistically significant difference in the LL, cranial adjacent DD or DH, and adjacent caudal or cranial FD, SA, proportion of patients with smoking or hypertension or diabetes or invasion of the facet joint. Conclusion: ASD is less likely to occur in the early stage after single-segment OLIF, while ASD after multiple-segment OLIF mainly occurs at the caudal end, especially when the caudal vertebral body of the surgical segment is L5. Age, preoperative caudal adjacent segment disc degeneration, and osteoporosis are potential factors related to ASD after multiple-segment OLIF.

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Lumbar adjacent segment degeneration after spinal fusion surgery: a systematic review and meta-analysis

Cited by 4 publications

References 43 publications

Clinical outcomes of Short Rod Technique in transforaminal lumbar interbody fusion surgery through Wiltse approach: A case series report

Clinical outcomes of Short Rod Technique in transforaminal lumbar interbody fusion surgery through Wiltse approach: A case series report

The lumbar adjacent-level syndrome: analysis of clinical, radiological, and surgical parameters in a large single-center series

Characteristics of Adjacent Segment Disease Following Oblique Lateral Interbody Fusion：A retrospective study

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