Estimating the risk for symptomatic adjacent segment degeneration after lumbar fusion: analysis from a cohort of patients undergoing revision surgery

Abstract The incidence of cervical and lumbar fusion surgery has increased in the past twenty years, and during follow-up some of these patients develop changes at the adjacent segment. Recognizing that adjacent segment degeneration and disease may occur in the future does not alter the rating for a cervical or lumbar fusion at the time the patient's condition is determined to be at maximum medical improvement (MMI). The term adjacent segment degeneration refers to the presence of radiographic findings of degenerative disc disease, including disc space narrowing, instability, and so on at the motion segment above or below a cervical or lumbar fusion. Adjacent segment disease refers to the development of new clinical symptoms that correspond to these changes on imaging. The biomechanics of adjacent segment degeneration have been studied, and, although the exact mechanism is uncertain, genetics may play a role. Findings associated with adjacent segment degeneration include degeneration of the facet joints with hypertrophy and thickening of the ligamentum flavum, disc space collapse, and translation—but the clinical significance of these radiographic degenerative changes remains unclear, particularly in light of the known presence of abnormal findings in asymptomatic patients. Evaluators should not rate an individual in anticipation of the development of changes at the level above a fusion, although such a development is a recognized possibility.

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Risk factors for predicting symptomatic adjacent segment degeneration requiring surgery in patients after posterior lumbar fusion

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-014-0097-0 ◽

2014 ◽

Vol 9 (1) ◽

Cited By ~ 24

Author(s):

Jinqian Liang ◽

Yulei Dong ◽

Hong Zhao

Keyword(s):

Risk Factors ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Posterior Lumbar Fusion

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Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion

The Spine Journal ◽

10.1016/j.spinee.2016.03.010 ◽

2016 ◽

Vol 16 (7) ◽

pp. 867-875 ◽

Cited By ~ 29

Author(s):

Jong Yeol Kim ◽

Dal Sung Ryu ◽

Ho Kyu Paik ◽

Sang Soak Ahn ◽

Moo Sung Kang ◽

...

Keyword(s):

Risk Factors ◽

Facet Joint ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Paraspinal Muscle ◽

Adjacent Segment

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Radiologic adjacent segment degeneration 2 years after lumbar fusion for degenerative spondylolisthesis

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2016.03.012 ◽

2016 ◽

Vol 102 (6) ◽

pp. 759-763 ◽

Cited By ~ 12

Author(s):

P.-E. Moreau ◽

E. Ferrero ◽

G. Riouallon ◽

T. Lenoir ◽

P. Guigui

Keyword(s):

Lumbar Fusion ◽

Degenerative Spondylolisthesis ◽

Adjacent Segment Degeneration ◽

Adjacent Segment

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Is the Goutallier grade of multifidus fat infiltration associated with adjacent-segment degeneration after lumbar spinal fusion?

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20238 ◽

2020 ◽

pp. 1-6

Author(s):

Ping-Guo Duan ◽

Praveen V. Mummaneni ◽

Jeremy M. V. Guinn ◽

Joshua Rivera ◽

Sigurd H. Berven ◽

...

Keyword(s):

Revision Surgery ◽

Demographic Data ◽

Degenerative Spondylolisthesis ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Fat Infiltration ◽

Single Level ◽

Goutallier Classification ◽

Spinopelvic Parameter

OBJECTIVEThe aim of this study was to investigate whether fat infiltration of the lumbar multifidus (LM) muscle affects revision surgery rates for adjacent-segment degeneration (ASD) after L4–5 transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis.METHODSA total of 178 patients undergoing single-level L4–5 TLIF for spondylolisthesis (2006 to 2016) were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, preoperative MR images and radiographs, and single-level L4–5 TLIF for degenerative spondylolisthesis. Twenty-three patients underwent revision surgery for ASD during the follow-up. Another 23 patients without ASD were matched with the patients with ASD. Demographic data, Roussouly curvature type, and spinopelvic parameter data were collected. The fat infiltration of the LM muscle (L3, L4, and L5) was evaluated on preoperative MRI using the Goutallier classification system.RESULTSA total of 46 patients were evaluated. There were no differences in age, sex, BMI, or spinopelvic parameters with regard to patients with and those without ASD (p > 0.05). Fat infiltration of the LM was significantly greater in the patients with ASD than in those without ASD (p = 0.029). Fat infiltration was most significant at L3 in patients with ASD than in patients without ASD (p = 0.017). At L4 and L5, there was an increasing trend of fat infiltration in the patients with ASD than in those without ASD, but the difference was not statistically significant (p = 0.354 for L4 and p = 0.077 for L5).CONCLUSIONSFat infiltration of the LM may be associated with ASD after L4–5 TLIF for spondylolisthesis. Fat infiltration at L3 may also be associated with ASD at L3–4 after L4–5 TLIF.

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Impact of patient-specific factors and spinopelvic alignment on the development of adjacent segment degeneration after short-segment lumbar fusion

10.21203/rs.3.rs-898513/v1 ◽

2021 ◽

Author(s):

László Kiss ◽

Zsolt Szövérfi ◽

Ferenc Bereczki ◽

Péter Endre Éltes ◽

Balázs Szöllösi ◽

...

Keyword(s):

Disc Degeneration ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Patient Specific ◽

Adjacent Segment ◽

Short Segment ◽

Adjacent Disc ◽

Disc Bulge ◽

Specific Factors

Abstract Objectives: The main purpose of the study was to analyse the different demographical, morphological, and surgery-related parameters influencing the development or progress of degeneration in adjacent segments after routine, short-segment lumbar fusions.Summary of Background data: Adjacent segment degeneration (ASD) considered as a major long-term complication after lumbar fusions. Possible risk factors are related to the patients’ demographics, spinopelvic anatomy or preoperative lumbar intervertebral disc conditions. The current literature lacks of well-designed prospective studies focusing on the multidimensional nature of the condition.Methods: A prospective cohort of 100 patients who underwent one- or two-level lumbar transforaminal interbody fusions due to lumbar degenerative pathology was conducted. Demographical, radiological findings (spinopelvic parameters, adjacent segmental radiological as well as magnetic resonance imaging (MRI) features) and long-term outcome data (5-year) were analysed to identify factors associated with ASD. Results: ASD patients showed higher level of pain (p=0.004) and disability (p=0.020) at follow-up. In univariate analysis, older age, upper-level lumbar fusion (p=0.007), lower L4-S1 lordosis (p=0.039), PI-LL mismatch (p=0.021), Pfirrmann grade III or higher disc degeneration (p=0.002) and the presence of disc bulge/herniation were (p=0.007) associated with ASD. Final result of multivariate analysis showed major degenerative sign (disc degeneration and/or disc bulge) as a risk factor (OR 3.85, CI 1.43-10.37, p=0.006).Conclusion: By examining the role of different patient- and procedure-specific factors, we found that preoperative major degenerative signs at the adjacent segment increase the risk of ASD causing significantly worse outcome after short-segment lumbar fusion. Adjacent disc conditions should be considered carefully during surgical planning.

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