Risk Factors of Adjacent Segment Disease Requiring Surgery After Lumbar Spinal Fusion

Lee, Jae Chul; Kim, Yongdai; Soh, Jaewan; Shin, Byung-Joon

doi:10.1097/brs.0000000000000164

Cited by 145 publications

(68 citation statements)

References 28 publications

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“…A previous FE analysis has shown that removing the posterior complex during decompression with posterolateral fusion could cause potential adjacent segmental instability [10]. Moreover, PLIF has been reported to be more rigid than posterolateral fusion [28, 29], and hence patients who undergo are likely to experience a higher incidence of ASD than those who underwent posterolateral fusion [30]. However, most previous PLIF FE analyses have neglected the importance of posterior complex and focused on the altered biomechanical behavior in the fused lumbar spine with spinal fixators and cages [16, 17, 24, 28, 29].…”

Section: Discussionmentioning

confidence: 99%

Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis

Huang

Cheng³

et al. 2016

PLoS ONE

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ObjectiveTo investigate the biomechanical effects of the lumbar posterior complex on the adjacent segments after posterior lumbar interbody fusion (PLIF) surgeries.MethodsA finite element model of the L1–S1 segment was modified to simulate PLIF with total laminectomy (PLIF-LAM) and PLIF with hemilaminectomy (PLIF-HEMI) procedures. The models were subjected to a 400N follower load with a 7.5-N.m moment of flexion, extension, torsion, and lateral bending. The range of motion (ROM), intradiscal pressure (IDP), and ligament force were compared.ResultsIn Flexion, the ROM, IDP and ligament force of posterior longitudinal ligament, intertransverse ligament, and capsular ligament remarkably increased at the proximal adjacent segment in the PLIF-LAM model, and slightly increased in the PLIF-HEMI model. There was almost no difference for the ROM, IDP and ligament force at L5-S1 level between the two PLIF models although the ligament forces of ligamenta flava remarkably increased compared with the intact lumbar spine (INT) model. For the other loading conditions, these two models almost showed no difference in ROM, IDP and ligament force on the adjacent discs.ConclusionsPreserved posterior complex acts as the posterior tension band during PLIF surgery and results in less ROM, IDP and ligament forces on the proximal adjacent segment in flexion. Preserving the posterior complex during decompression can be effective on preventing adjacent segment degeneration (ASD) following PLIF surgeries.

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Section: Discussionmentioning

confidence: 99%

Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis

Huang

Cheng³

et al. 2016

PLoS ONE

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“…ASD is one reason reoperations are necessary and have a higher incidence in elderly patients. 22 The probability of undergoing a revision surgery for ASD was 5.8% at 5 years and 10.4% and 10 years postoperatively. 22 The prevalence of ASD requiring reoperation in patients older than 60 years of age was 21.9% at 10 years postoperatively.…”

Section: Discussionmentioning

confidence: 93%

“… 22 The probability of undergoing a revision surgery for ASD was 5.8% at 5 years and 10.4% and 10 years postoperatively. 22 The prevalence of ASD requiring reoperation in patients older than 60 years of age was 21.9% at 10 years postoperatively. 22 PLIF procedures showed significantly lower survival rates than PLF procedures.…”

Section: Discussionmentioning

confidence: 93%

The Effects of Single-Level Instrumented Lumbar Laminectomy on Adjacent Spinal Biomechanics

Bisschop

Holewijn

Kingma

et al. 2014

Global Spine Journal

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Study Design Biomechanical study. Objective Posterior instrumentation is used to stabilize the spine after a lumbar laminectomy. However, the effects on the adjacent segmental stability are unknown. Therefore, we studied the range of motion (ROM) and stiffness of treated lumbar spinal segments and cranial segments after a laminectomy and after posterior instrumentation in flexion and extension (FE), lateral bending (LB), and axial rotation (AR). These outcomes might help to better understand adjacent segment disease (ASD), which is reported cranial to the level on which posterior instrumentation is applied. Methods We obtained 12 cadaveric human lumbar spines. Spines were axially loaded with 250 N for 1 hour. Thereafter, 10 consecutive load cycles (4 Nm) were applied in FE, LB, and AR. Subsequently, a laminectomy was performed either at L2 or at L4. Thereafter, load-deformation tests were repeated, after similar preloading. Finally, posterior instrumentation was added to the level treated with a laminectomy before testing was repeated. The ROM and stiffness of the treated, the cranial adjacent, and the control segments were calculated from the load-displacement data. Repeated-measures analyses of variance used the spinal level as the between-subject factor and a laminectomy or instrumentation as the within-subject factors. Results After the laminectomy, the ROM increased (+19.4%) and the stiffness decreased (−18.0%) in AR. The ROM in AR of the adjacent segments also increased (+11.0%). The ROM of treated segments after instrumentation decreased in FE (−74.3%), LB (−71.6%), and AR (−59.8%). In the adjacent segments after instrumentation, only the ROM in LB was changed (−12.9%). Conclusions The present findings do not substantiate a biomechanical pathway toward or explanation for ASD.

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“…Lumbar fusion surgery is the primary therapy for multi-level lumbar degenerative disease, but complications may occur, especially acceleration of ASD [20, 21]. Following improved knowledge of lumbar motion function, dynamic stabilization techniques developed quickly, and posterior dynamic stabilization has been accepted and used by more and more spine surgeons.…”

Section: Discussionmentioning

confidence: 99%

The influence of L4–S1 Dynesys® dynamic stabilization versus fusion on lumbar motion and its relationship with lumbar degeneration: a retrospective study

et al. 2017

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BackgroundThe aim of this study is to evaluate the efficacy of Dynesys® posterior dynamic stabilization (PDS) in the treatment of L4–S1 degenerative diseases and to assess the influence of postoperative motion on lumbar degeneration.MethodsIncluded in this retrospective study were patients with L4–S1 degenerative disease who underwent fusion or PDS from September 2010 to September 2014. Clinical outcomes were assessed by preoperative and postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI). Preoperative and postoperative X-rays assessed range of motion (ROM) of the non-surgical and surgical levels and whole lumbar. MRI assessed degeneration of non-surgical levels.ResultsA total of 56 consecutive patients were divided into two groups: group A, PDS, and group B, fusion. Patient demographics and baseline characteristics were similar in the two groups. In both groups, there was a significant difference between preoperative and postoperative VAS and ODI scores (P < 0.05). However, there was a significant difference in a 6-month follow-up ODI between the two groups (P < 0.05). X-rays showed PDS patients partially maintained surgical level ROM and non-surgical level ROM increased less than in the fusion group. MRI showed adjacent segment degeneration (ASD) in both groups, and patients whose preoperative L3–4 Pfirrmann classification was higher than grade 2 had more ASD than lower than grade 2.ConclusionPDS can maintain surgical level ROM and had less influence on whole and non-surgical level ROM. Following PDS, patients recovered faster and had a better lumbar function. It may be a better choice for multi-level lumbar degenerative diseases.

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Risk Factors of Adjacent Segment Disease Requiring Surgery After Lumbar Spinal Fusion

Abstract: 3.

Cited by 145 publications

References 28 publications

Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis

Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis

The Effects of Single-Level Instrumented Lumbar Laminectomy on Adjacent Spinal Biomechanics

The influence of L4–S1 Dynesys® dynamic stabilization versus fusion on lumbar motion and its relationship with lumbar degeneration: a retrospective study

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