Surgical Treatment of Adjacent Instability After Lumbar Spine Fusion

Chen, Wen-Jer; Lai, Po‐Liang; Niu, Chi‐Chien; Chen, Lih-Huei; Fu, Tsai-Sheng; Wong, Chak-Bor

doi:10.1097/00007632-200111150-00024

Cited by 134 publications

(79 citation statements)

References 22 publications

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“…The interval between the index and revision surgery has been reported to range from 5.2 to 7.1 years [1,4,22]. The comparatively short interval in this study (4.4 years, 52.3 months) may be due to differences in type of fusion and patient population.…”

Section: Discussionmentioning

confidence: 59%

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Risk factors for adjacent segment disease after lumbar fusion

et al. 2009

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The incidence of adjacent segment problems after lumbar fusion has been found to vary, and risk factors for these problems have not been precisely verified, especially based on structural changes determined by magnetic resonance imaging. The purpose of this retrospective clinical study was to describe the incidence and clinical features of adjacent segment disease (ASD) after lumbar fusion and to determine its risk factors. We assessed the incidence of ASD in patients who underwent lumbar or lumbosacral fusions for degenerative conditions between August 1995 and March 2006 with at least a 1-year followup. Patients less than 35 years of age at the index spinal fusion, patients with uninstrumented fusion, and patients who had not achieved successful union were excluded. Of the 1069 patients who underwent fusions, 28 (2.62%) needed secondary operations because of ASD and were included in this study. In order to identify the risk factors, we matched a disease group and a control group. The disease group consisted of 26 of the 28 patients with ASD, excluding the 2 patients for whom we did not have initial MRI data. Each patient in the disease group was matched by age, sex, fusion level and follow-up period with a control patient. The assumed risk factors included disc and facet degeneration, instability, listhesis, rotational deformity, and disc wedging. The mean age of the 28 patients with ASD requiring surgical treatment was 58.4 years, which did not differ significantly from that of the population in which ASD did not develop (58.2 years, p = 0.894). Of the 21 patients who underwent floating fusion, only 1 developed distal ASD. Facet degeneration was a significant risk factor (p \ 0.01) on logistic regression analysis. The incidence of distal ASD was much lower than that of proximal ASD. Pre-existing facet degeneration may be associated with a high risk of adjacent segment problems following lumbar fusion procedures.

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Section: Discussionmentioning

confidence: 59%

“…It is evident that the number of surgical interventions for ASD will increase as more spinal fusions are performed. To date, however, only a few reports on the results of revision surgery for ASD have been published [1,4,22].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for adjacent segment disease after lumbar fusion

et al. 2009

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“…The reported incidence of symptomatic adjacent segment disease has ranged from 5 to 20% in studies with varying follow-up time and with different techniques to achieve fusion (Park et al 2004). Surgical treatment includes decompression and extended fusion, but the results are modest and the treatment must be given with correspondingly moderate patient expectations (Whitecloud et al 1994, Phillips et al 2000, Chen et al 2001.…”

Section: Discussionmentioning

confidence: 99%

Adjacent segment hypermobility after lumbar spine fusion: No association with progressive degeneration of the segment 5 years after surgery

2007

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Background and purpose Increased intradiscal pressure and relative segmental hypermobility are in vitro observations supporting the idea of increased postoperative load being a reason for progressive degeneration of the free mobile segment adjacent to a lumbar fusion. These mechanisms have been difficult to confirm in clinical studies, and an alternative theory claims instead that the adjacent segment degeneration follows a natural degenerative course in patients who are predisposed. We examined 9 patients 5 years after lumbar fusion, to assess whether relative hypermobility of the segment adjacent to fusion could be correlated to progressive degeneration of the same segment.Patients and methods The 9 patients, all of whom had been treated with a lumbar fusion after a preoperative intervertebral mobility assessment by spinal RSA, were re-examined 5 years after surgery. The intervertebral translations of the vertebra proximal to the fusion were determined by RSA and compared to the mobility of the same lumbar segment before fusion. The disc height and any progressive reduction at the two levels proximal to the one fused were measured on conventional radiographs.Results Adjacent segment mobility 5 years after fusion-expressed as mean transverse, vertical, and sagittal translation of the vertebra proximal to fusionwas not significantly changed compared to the mobility measured before surgery. Increased mobility of the segment seen in 5 individual patients was not associated with progressive degeneration of the same segment or to a poor clinical outcome.

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“…Some cases have undergone decompression surgery, whereas others have undergone adjunctive fusion surgery [5][6][7][8][9]. Till date, no study has compared operative procedures for ASD [9].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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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.

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Surgical Treatment of Adjacent Instability After Lumbar Spine Fusion

Cited by 134 publications

References 22 publications

Risk factors for adjacent segment disease after lumbar fusion

Risk factors for adjacent segment disease after lumbar fusion

Adjacent segment hypermobility after lumbar spine fusion: No association with progressive degeneration of the segment 5 years after surgery

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

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