Postoperative Radiographic Early-Onset Adjacent Segment Degeneration after Single-Level L4–L5 Posterior Lumbar Interbody Fusion in Patients without Preoperative Severe Sagittal Spinal Imbalance

Abstract

Study DesignRetrospective study.PurposeTo investigate the relationship between preoperative total spinal sagittal alignment and the early onset of adjacent segment degeneration (ASD) after single-level posterior lumbar interbody fusion (PLIF) in patients with normal sagittal spinal alignment.Overview of LiteraturePostoperative early-onset ASD is one of the complications after L4–L5 PLIF, a common surgical procedure for lumbar degenerative disease in patents without severe sagittal imbalance. A better understanding of the preoperative characteristics of total spinal sagittal alignment associated with early-onset ASD could help prevent the condition.MethodsThe study included 70 consecutive patients diagnosed with lumbar degenerative disease who underwent single-level L4–L5 PLIF between 2011 and 2015. They were divided into two groups based on the radiographic progression of L3–L4 degeneration after 1-year follow-up: the ASD and the non-ASD (NASD) group. The following radiographic parameters were preoperatively and postoperatively measured: sagittal vertebral axis (SVA), thoracic kyphosis (TK), lumbar lordosis, pelvic tilt, and pelvic incidence (PI).ResultsEight of the 70 patients (11%) experienced ASD after PLIF (three males and five females; age, 64.4±7.7 years). The NASD group comprised 20 males and 42 females (age, 67.7±9.3 years). Six patients of the ASD group showed decreased L3–L4 disc height, one had L3–L4 local kyphosis, and one showed both changes. Preoperative SVA, PI, and TK were significantly smaller in the ASD group than in the NASD group (p <0.05).ConclusionsA preoperative small SVA and TK with small PI were the characteristic alignments for the risk of early-onset ASD in patients without preoperative severe sagittal spinal imbalance undergoing L4–L5 single-level PLIF.

Preoperative Risk Factors for Adjacent Segment Degeneration after Two-Level Floating Posterior Fusion at L3-L5

“…In contrast, spinopelvic imbalance has been reported to be associated with ASD and an unsatisfactory clinical outcome, even in short fusion cases that were not performed to correct spinal align- 40,41) . In a study by Matsuoka et al that included 70 patients who underwent single-level L4-L5 fusion, preoperative small sagittal vertebral axis and thoracic kyphosis with small pelvic incidence were identified as risk factors for RASD 42) . Therefore, further studies are needed to determine the relationship between multilevel floating fusion and sagittal alignment of the spine.…”

Comparison of Nitinol and Titanium Nails Effectiveness for Lumbosacral Spine Fixation in Surgical Treatment of Degenerative Spine Diseases

“…активное внедрение металлофиксаторов привело к значительному увеличению числа хирургических вмешательств с фиксацией оперируемого сегмента, проводимых после процедур декомпрессии, и вызвало некоторую озабоченность по поводу чрезмерного использования этой технологии для стабилизации дегенеративных сегментов позвоночника [8], поскольку транспедикулярная фиксация обладает осложнениями, такими как болезнь смежного сегмента, развитие псевдоартроза, нестабильность металлоконструкции [14,15]. Также стоит отметить, что формирование костного блока негативно влияет на мышечную ткань, вызывая атрофию и снижение мышечной силы.…”

Impact of patient-specific factors and spinopelvic alignment on the development of adjacent segment degeneration after short-segment lumbar fusion

“…(5-7) Morphological changes can be determined on standing X-rays using various parameters such as intervertebral disc height reduction, listhesis or change in segmental angle. (8)(9)(10)(11)(12) Numerous papers reported various factors associated with ASD such as age, female gender, body mass index (BMI), change in lumbar and segmental lordosis, high pelvic incidence, sagittal malalignment, preoperative disc degeneration and length of fusion respectively. (13)(14)(15)(16)(17)(18)(19)(20)(21)(22) Some of these risk factors are related to the patients' demographics or spinopelvic anatomy.…”