Risk factors for upper adjacent segment degeneration after multi-level posterior lumbar spinal fusion surgery

Abstract

Background Posterior lumbar spinal fusion has been widely used in degenerative lumbar stenosis, but adjacent segment degeneration (ASD) was common. Researchers have found many risk factors for ASD after one or two levels of surgery, but few clinical studies focused on multi-level surgery. The purpose of this study was to clarify risk factors for upper ASD after multi-level posterior lumbar spinal fusion. Methods A retrospective study was performed on the clinical data of 71 patients with degenerative lumbar stenosis who underwent multi-level (at least 3 levels) posterior lumbar spinal fusion from January 2013 to December 2016. Two groups were divided according to lamina and posterior ligamentous complex (PLC) maintenance of proximal fixed vertebrae in surgery. In the 22 patients of group A, the proximal fixed vertebral lamina and PLC were not resected, and in the 49 patients of group B, the proximal fixed vertebral lamina and PLC were resected completely. Age, sex, body mass index (BMI), number of fixed vertebrae and fused levels, spinopelvic parameters, coronal Cobb angle, and modified Pfirrmann grading system were measured for each patient. A Cox proportional hazards model was used to analyze risk factors for upper ASD. Results No symptomatic ASD was found during the follow-up period. Patients who underwent proximal fixed vertebral lamina and PLC resection had a significantly higher percentage of radiographic ASD ( P = 0.042). The Cox proportional hazards model showed that age, sex, BMI, preoperative lumbar lordosis, sacral slope, pelvic tilt, coronal Cobb angle, number of fixed vertebrae, and interbody fusion levels had no significant differences for radiographic ASD. But a preoperative modified Pfirrmann grade higher than 3, a high degree of preoperative pelvic incidence, and more decompressed levels had statistical significance ( P = 0.024, 0.041, and 0.008, respectively). Conclusions A preoperative modified Pfirrmann grade higher than 3, a high degree of preoperative pelvic incidence, and more decompressed levels might be risk factors for upper radiographic ASD after multi-level posterior lumbar spinal fusion surgery.

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

“…(21,33,34) In our study, P rrmann grade III + severe disc degeneration and presence of disc bulge/protrusion in adjacent segment was signi cantly higher in ASD group. Similar ndings were published by Ma, Ghasemi and Kim et al (13,25,33). More degenerated segments can be more vulnerable for the altered biomechanics resulting in the development of clinically signi cant ASD.…”

Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders: a meta-analysis

“…Eight studies (1492 of 2896 patients) [ 14 , 16 , 19 , 20 , 22 , 23 , 29 , 30 ] reported pre- and post-operative SS between ASD group and non-ASD group. There was no significance in the test for heterogeneity and the studies had low heterogeneity (two p for heterogeneity = 0.92, 0.66; I 2 = 0, 0%, Fig.…”

“…Although many scholars pay more attention to ASD after spine surgery, the risk factors associated with ASD are controversial. Thus, we perform a meta-analysis to evaluate the risk factors associated with ASD [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. The rate of ASD after posterior lumbar fusion surgery was 18.6% (ranged from 8.5 to 69.4%) in this study.…”

“…Fifteen studies (2592 of 2896 patients) [12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] reported gender between ASD group and non-ASD group. There was no significance in the test for heterogeneity and the studies had low heterogeneity (p for heterogeneity = 0.89; I 2 = 0%, Fig.…”

A Case of Thoracic Spondylosis Deformans and Multilevel Instrumented Spinal Fusion in an 84-Year-Old Male

“…Spinal fusion surgeries are performed in cases of traumatic instability, or when decompression surgery at multiple levels creates this instability. The pathological manifestations of ASD can include degeneration, listhesis, instability, herniation, and osteophyte formation [ 15 – 17 ]. The etiologies of ASD involve complex biomechanical processes and can be categorized as leading to either increased degeneration or to increased motion in the neighboring segments.…”