Symptomatic adjacent segment degeneration at the L3–4 level after fusion surgery at the L4–5 level: evaluation of the risk factors and 10-year incidence

Heo, Yeon; Park, Jin Hoon; Seong, Han Yu; Lee, Youngseok; Jeon, Sang Ryong; Rhim, Seung Chul; Roh, Sung Woo

doi:10.1007/s00586-015-4188-3

Cited by 52 publications

(35 citation statements)

References 38 publications

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“…Various risk factors for ASD after one-segment fusion have been reported, including age and sex, preoperative adjacent disc degeneration, sagittal malalignment, number of segments fused, laminar inclination, facet tropism, and excessive distraction of the disc space 6,[12][13][14][15][16][17][18][19] . However, in the present study, there was no significant association of age, sex, or preoperative disc degeneration with RASD, and the only risk factor was a preoperative absolute value of UIV tilt >10°(i.e., preoperative UIV tilt > 10°or UIV tilt < −10°).…”

Section: Discussionmentioning

confidence: 99%

“…A variety of risk factors for ASD after lumbar spine fu-sion surgery have been reported, including the length of the fusion, sagittal malalignment, age and sex, preoperative ASD, laminar inclination, facet tropism, and excessive disc distraction 6,[12][13][14][15][16][17][18][19] . It is known that the greater the number of fused segments the greater the risk of ASD.…”

Section: Introductionmentioning

confidence: 99%

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

Ushio

Hirai

Yoshii

et al. 2020

Spine Surg Relat Res

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Introduction: The aims of this study were to investigate how adjacent segment degeneration (ASD) occurs at the proximal and distal segments after L3-L5 fusion surgery, namely, floating fusion, and to identify the risk factors for ASD in patients who undergo this surgery. Methods: Fifty patients who underwent floating fusion surgery at vertebrae L3-L5 and developed ASD were enrolled. The following parameters were evaluated: body mass index (BMI), diabetes status, dialysis status, lumbar lordosis, segmental lordosis between the L2 upper endplate and the L3 lower endplate, disc height, Cobb's angle, apical vertebral rotation using the Nash and Moe classification method, preoperative disc degeneration, surgical procedures, and the upper instrumented vertebra (UIV) tilt angle. The UIV tilt angle was defined as positive when the anterior side was directed caudally. Results: Twenty-two (44%) of the 50 patients showed cephalad radiographic ASD (RASD) and 5 patients (10%) showed caudad RASD. Clinically symptomatic ASD was found at L2-L3 in 4 patients (8%) and at L5-S1 in 2 patients (4%). All the patients with clinically symptomatic cephalad ASD underwent revision procedures for radiculopathy or claudication because of degenerative pathology at L3-L4. Multivariate regression analysis showed a significant association of the absolute value of UIV tilt angle (mean |UIV tilt|) with cephalad RASD (odds ratio 1.09, p = 0.038). Receiver-operating characteristic curve analysis showed a significant association of |UIV tilt| >10.3°with RASD (sensitivity 67.9%, specificity 77.3%, area under the curve [AUC] 0.675). Conclusions: RASD was more likely to occur at the adjacent segment on the cephalad side than at the adjacent segment on the caudad side after two-segment floating fusion of L3-L5. A preoperative UIV tilt angle >10°or UIV tilt < −10°was a risk factor for RASD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Ushio

Hirai

Yoshii

et al. 2020

Spine Surg Relat Res

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“…The increased rigidity conferred by the addition of an interbody device may contribute to elevated rates of adjacent segment degeneration (ASD) and compression fracture [23][24][25][26]. However, conflicting data indicate that IBF may instead protect against ASD by generating more segmental lordosis [27].…”

Section: Indications For Interbody Fusionmentioning

confidence: 99%

Interbody Fusion Techniques in the Surgical Management of Degenerative Lumbar Spondylolisthesis

Derman

Albert

2017

Curr Rev Musculoskelet Med

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The existing evidence is mixed regarding the indications for and utility of IBF in DLS, but its use in the setting of pre-operative instability is most strongly supported. Anterior (ALIF), lateral (LLIF), posterior (PLIF), transforaminal (TLIF), and axial (AxiaLIF) lumbar IBF approaches have been described. While the current data are limited, TLIF may be a better option than PLIF in DLS due the increased operative morbidity and peri-operative complications observed with the latter. LLIF also appears superior to PLIF in light of improved radiologic outcomes, fewer intra-operative complications, and potentially greater improvements in disability. The data comparing LLIF to TLIF are less conclusive. No studies specifically comparing ALIF or AxiaLIF to other IBF techniques could be identified. Instability may be the strongest indication for IBF in DLS. When IBF is employed, the authors' preferred technique is TLIF with posterior segmental spinal instrumentation. Further research is needed.

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“…Though rigid fusion has been proved to be an effective way to restore the disc space height, reconstruct the stability and alignment of spine, a variety of complications had emerged such as adjacent segment disease with the change of spinal mechanical activities [12]. The rigid fusion decreased the flexibility and mobility of the entire lumbar spine, leading to the center of rotation of vertebral body shifts over the disc, consequently, the stress on the facets and/or disc of the adjacent mobile segment significantly increased [4]. The increased stress will lead to a significant effect on intersegmental mobility and the increase in intradiscal pressure, overall, it accelerates degenerative changes at adjacent unfused segment, especially at the cranial level [13].…”

Section: Discussionmentioning

confidence: 99%

“…Due to spinal fusion surgery has significantly facilitated patient comfort and mobility, fusion is regarded as a gold standard treatment for degenerative lumbar spine disease. However, we cannot ignore the fact that many researchers have demonstrated that fusion can accelerate the degeneration of adjacent lumbar segment, due to it can lead to excessive stress at unfused adjacent levels [4,5]. Therefore, society of spine surgery holds the promise to develop an effective method to prevent or slow down the progress of adjacent segmental degeneration (ASD), after surgical treatment of lumbar degenerative disorders [6].…”

Section: Introductionmentioning

confidence: 99%

Effect of Coflex interspinous stabilization on the prevention of progression of adjacent segment degeneration after single level and skipped level spinal fusion in a canine model

Liang

Lin

Ding

et al. 2019

Preprint

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Background Interspinous spacer (ISPs) was a promising treatment method for adjacent segment degeneration (ASD) after spinal fusion. Coflex, one of ISPs, has been deceived to prevent or decelerate ASD after spinal fusion, while the proof of the effectiveness of such device is still very limited. The purpose of this study was further to investigate the protection role of Coflex in vivo after spinal fusion, when implanted in adjacent segment and middle segment. Methods Three groups of beagles were allocated as follows (n=6): (1)L4-5 lumbar interbody fusion(IF). (2) L4-5 lumbar interbody fusion +L5-6 interspinous Coflex implantation(Cof1).(3) L4-5 and L6-7 interbody fusion+ L5-6 interspinous Coflex implantation (Cof2). In all animals, L5-6 discs were punctured to generate degeneration, and the intact L2–3 disc served as a noninjuries control (Con group). The effectiveness of Coflex on the prevention or deceleration of the progression of ASD was determined by magnetic resonance imaging, gross anatomical observation, histological and immunohistochemically analysis, and Real-time PCR analysis of gene expression. Results The objective disc in every group showed degeneration, however, the degeneration was more significant in IF group than Cof1 and Cof2 groups. MRI and histologic assay demonstrated that the discs of Cof1 and Cof2 groups maintained a relatively well-preserved structure as compared to the discs of IF group. Furthermore, immunohistochemistry analysis and real-time PCR demonstrated that the indicators of disc degeneration, TIMP1, BMP2, Col I, were up-regulated and disc matrix gene, Col II was down-regulated in IF group significantly Conclusions Coflex could decelerate the progression of ASD after spinal fusion, and it holds the same value not only at adjacent segment after single level spinal fusion, but also dose at the middle segment after “skipped” level (nonconsecutive) fusion

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Symptomatic adjacent segment degeneration at the L3–4 level after fusion surgery at the L4–5 level: evaluation of the risk factors and 10-year incidence

Cited by 52 publications

References 38 publications

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

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

Interbody Fusion Techniques in the Surgical Management of Degenerative Lumbar Spondylolisthesis

Effect of Coflex interspinous stabilization on the prevention of progression of adjacent segment degeneration after single level and skipped level spinal fusion in a canine model

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