Adjacent Segment Degeneration After Single-segment PLIF: the Risk Factor for Degeneration and Its Impact on Clinical Outcomes

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2011 Jul 2

PMID 21720728

Citations 27

Authors

Bai-Ling Chen

Fu-Xin Wei

Kazumasa Ueyama

Deng-Hui Xie

Akio Sannohe

Shao-Yu Liu

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate: (1) the risk factors for radiologic cranial adjacent segment degeneration (ASD) after single-segment PLIF at the same level, and (2) the impact of the ASD on the clinical outcomes.

Methods: From October 2004 to May 2009, 109 patients who underwent PLIF for degenerative instability at L4/5 and have more than 2 years follow-up were studied retrospectively. We measured the preoperative bone mineral density (BMD), lumbar lordosis, the lumbosacral joint angle, the lumbar inclination, the height and the dynamic angulation of the intervertebral space at the fused segments and the upper adjacent segment, the sliding displacement between L3 and L4. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score and the Oswestry Disability Index (ODI). Patients were divided into two groups according to the progression of L3-L4 degeneration: Group A without progression of L3-L4 degeneration, Group B with progression of L3-L4 degeneration. Clinical outcomes and radiologic measurement index between the two groups were compared, and the risk factors for progression of L3-L4 degeneration were analyzed. The correlation between clinical outcomes and progression of L3-L4 degeneration were also investigated.

Results: There were 11 patients (22%) classified into Group A. No significant difference was found between the two groups in terms of the lordosis angle at L1 and S1, the laminar inclination at L3, the pre-existing L3-L4 disk degeneration, the lordosis angle of L4-L5, the lumbosacral joint angle and preoperative BMD (P > 0.05). Significant differences were found between the two groups in age. No significant difference was found between the two groups in the ODI and the JOA score at the final follow-up (P > 0.05).

Conclusion: Radiologic degeneration of the cranial adjacent segment after single-segment PLIF did not significantly correlate with clinical outcomes. Age was a risk factor for radiologic degeneration, however, there was no significant correlation between degeneration and preoperative radiologic factors and bone mineral density (BMD).

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References

Lee C, Hwang C, Lee S, Ahn Y, Kim Y, Lee D . Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J. 2009; 18(11):1637-43. PMC: 2899393. DOI: 10.1007/s00586-009-1060-3. View

Chen C, Cheng C, Liu C . A biomechanical comparison of posterolateral fusion and posterior fusion in the lumbar spine. J Spinal Disord Tech. 2002; 15(1):53-63. DOI: 10.1097/00024720-200202000-00010. View

Aota Y, Kumano K, Hirabayashi S . Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J Spinal Disord. 1995; 8(6):464-73. View

Ekman P, Moller H, Shalabi A, Yu Y, Hedlund R . A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration. Eur Spine J. 2009; 18(8):1175-86. PMC: 2899511. DOI: 10.1007/s00586-009-0947-3. View

Umehara S, Zindrick M, Patwardhan A, Havey R, Vrbos L, Knight G . The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine (Phila Pa 1976). 2000; 25(13):1617-24. DOI: 10.1097/00007632-200007010-00004. View

Cheh G, Bridwell K, Lenke L, Buchowski J, Daubs M, Kim Y . Adjacent segment disease followinglumbar/thoracolumbar fusion with pedicle screw instrumentation: a minimum 5-year follow-up. Spine (Phila Pa 1976). 2007; 32(20):2253-7. DOI: 10.1097/BRS.0b013e31814b2d8e. View

Bastian L, Lange U, Knop C, Tusch G, Blauth M . Evaluation of the mobility of adjacent segments after posterior thoracolumbar fixation: a biomechanical study. Eur Spine J. 2001; 10(4):295-300. PMC: 3611504. DOI: 10.1007/s005860100278. View

Boden S, DAVIS D, Dina T, Patronas N, Wiesel S . Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990; 72(3):403-8. View

Kumar M, Baklanov A, Chopin D . Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J. 2001; 10(4):314-9. PMC: 3611507. DOI: 10.1007/s005860000239. View

10.

Kumar M, Jacquot F, Hall H . Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease. Eur Spine J. 2001; 10(4):309-13. PMC: 3611514. DOI: 10.1007/s005860000207. View

11.

Battie M, Videman T, Parent E . Lumbar disc degeneration: epidemiology and genetic influences. Spine (Phila Pa 1976). 2004; 29(23):2679-90. DOI: 10.1097/01.brs.0000146457.83240.eb. View

12.

Greenough C, Fraser R . Assessment of outcome in patients with low-back pain. Spine (Phila Pa 1976). 1992; 17(1):36-41. DOI: 10.1097/00007632-199201000-00006. View

13.

Yang S, Langrana N, Lee C . Biomechanics of lumbosacral spinal fusion in combined compression-torsion loads. Spine (Phila Pa 1976). 1986; 11(9):937-41. DOI: 10.1097/00007632-198611000-00014. View

14.

Park P, Garton H, Gala V, Hoff J, McGillicuddy J . Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976). 2004; 29(17):1938-44. DOI: 10.1097/01.brs.0000137069.88904.03. View

15.

Quinnell R, Stockdale H . Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Spine (Phila Pa 1976). 1981; 6(3):263-7. DOI: 10.1097/00007632-198105000-00008. View

16.

Seitsalo S, Schlenzka D, Poussa M, Osterman K . Disc degeneration in young patients with isthmic spondylolisthesis treated operatively or conservatively: a long-term follow-up. Eur Spine J. 1997; 6(6):393-7. PMC: 3467728. DOI: 10.1007/BF01834066. View

17.

Ghiselli G, Wang J, Hsu W, Dawson E . L5-S1 segment survivorship and clinical outcome analysis after L4-L5 isolated fusion. Spine (Phila Pa 1976). 2003; 28(12):1275-80; discussion 1280. DOI: 10.1097/01.BRS.0000065566.24152.D3. View

18.

Zencica P, Chaloupka R, Hladikova J, Krbec M . [Adjacent segment degeneration after lumbosacral fusion in spondylolisthesis: a retrospective radiological and clinical analysis]. Acta Chir Orthop Traumatol Cech. 2010; 77(2):124-30. View

19.

Okuda S, Oda T, Miyauchi A, Tamura S, Hashimoto Y, Yamasaki S . Lamina horizontalization and facet tropism as the risk factors for adjacent segment degeneration after PLIF. Spine (Phila Pa 1976). 2008; 33(25):2754-8. DOI: 10.1097/BRS.0b013e31817bb9c2. View

20.

Cho K, Kang S, Yoo D, Huh P, Kim D, Lee S . Risk factors and surgical treatment for symptomatic adjacent segment degeneration after lumbar spine fusion. J Korean Neurosurg Soc. 2009; 46(5):425-30. PMC: 2796347. DOI: 10.3340/jkns.2009.46.5.425. View