Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion

Abstract

Purpose Adjacent segment disease (ASD) is an increasing problematic complication following lumbar fusion surgeries. ASD requires appropriate treatment, although there are only few reports on surgery for ASD. This study aimed to clarify surgical outcomes of posterior lumbar interbody fusion (PLIF) for ASD. Methods Medical charts of 18 patients who underwent the second (repeat) PLIF for ASD were retrospectively investigated (average follow-up, 40 [27-66] months). Modified Japanese Orthopaedic Association (JOA) score and Whitecloud classification were used as outcome measures. Results Mean modified JOA score improved from 7.7 just before repeat PLIF to 11.4 at maximum recovery and declined to 10.2 at final follow-up. Mean recovery rate of modified JOA score was 52.9 % at maximum recovery and 31.6 % at final follow-up. According to Whitecloud classification, 17 patients (94 %) were excellent or good and only 1 was fair at maximum recovery, whereas 10 (56 %) were excellent or good, 6 were fair, and 2 were poor at final follow-up. Eight patients (44 %) deteriorated again because of recurrent ASD. Two poor patients underwent a third PLIF. Conclusion PLIF is effective for ASD after PLIF in the short term, although it tends to lead to a high incidence of recurrent ASD.

Lateral lumbar interbody fusion with unilateral pedicle screw fixation for the treatment of adjacent segment disease: a preliminary report

“…Surgical treatment of ASD presents many challenges, including high rates of complication due to the need for revision of prior posterior instrumentation (16)(17)(18). The principal surgeon hypothesized that the use of LLIF and unilateral pedicle screw fixation may provide sufficient treatment of the symptomatic ASD while minimizing the extent of revision required for surgery and the risk of associated complications.…”

Percutaneous Transforaminal Endoscopic Discectomy and Fenestration Discectomy to Treat Posterior Ring Apophyseal Fractures: A Retrospective Cohort Study

“…Currently, the choice of surgical method for lumbar PRAF is controversial. Although traditional open surgery can achieve a satisfactory neuro‐decompression effect, the operation is traumatic and will inevitably destroy the normal structure and motor function of the lumbar spine, which is likely to lead to long‐term accelerated degeneration of the adjacent segments and vertebral diseases22. With the development in percutaneous spinal endoscopy technology, indications for surgery have been gradually expanded8,23.…”

Effectiveness of Reoperations for Adjacent Segment Disease Following Lumbar Spinal Fusion

“…Indications for surgery for ASD included stenosis in 3 studies, [19][20][21] instability in 1 study, 22 and stenosis or instability in 1 study. 23 The surgical treatments for ASD included minimally invasive lateral fusion, 19 decompression and posterior lumbar interbody fusion, 20 decompression and posterolateral lumbar fusion, 21,22 and decompression with instrumented and noninstrumented posterolateral lumbar fusion. 23 Three studies reported on the average interval between initial fusion and surgical treatment for ASD, which was 8.2 years (range, 5.2-11.5 years).…”

“…[21][22][23] All of the studies reported on success rates following reoperation, both clinically and radiographically, and 4 of the studies reported revision rates following surgical treatment of ASD. [19][20][21][22]…”

“…Wang et al 19 reported the preoperative and postoperative back and leg pain, with noticeable decreases evident following reoperation. The study by Miwa et al 20 was the only one to provide Japanese Orthopedic Association scores, with mean values of 7.7 and 11.4 preoperatively and postoperatively, respectively. At final follow-up, the mean Japanese Orthopedic Association score had declined to 10.2.…”