540 ADJACENT SEGMENT LUMBAR FACET JOINT OSTEOARTHRITIS AND INTERVERTEBRAL DISC DEGENERATION AFTER POSTERIOR LUMBAR INTERBODY FUSION

Object A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operative management for multilevel DS raises more complicated issues. The purpose of this retrospective study was to elucidate clinical and radiological outcomes after 2-level PLIF for 2-level DS with the least bias in determination of operative procedure. Methods Since 2005, all patients surgically treated for lumbar DS at the authors' hospital have been treated using posterior lumbar interbody fusion (PLIF) with pedicle screws, irrespective of severity of slippage, patient age, or bone quality. The authors conducted a retrospective review of 20 consecutive cases involving patients who underwent 2-level PLIF for 2-level DS and had been followed up for 2 years or longer (2-level PLIF group). They also analyzed data from 92 consecutive cases involving patients who underwent single-level PLIF for single-level DS during the same time period and had been followed for at least 2 years (1-level PLIF group). This second group served as a control. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) score. Fusion status and sagittal alignment of the lumbar spine were assessed by comparing serial plain radiographs. Surgery-related complications and the need for additional surgery were evaluated. Results The mean JOA score improved significantly from 12.8 points before surgery to 20.4 points at the latest follow-up in the 2-level PLIF group (mean recovery rate 51.8%), and from 14.2 points preoperatively to 22.5 points at the latest follow-up in the single-level PLIF group (mean recovery rate 55.3%). At the final follow-up, 95.0% of patients in the 2-level PLIF group and 96.7% of those in the 1-level PLIF group had achieved solid spinal fusion, and the mean sagittal alignment of the lumbar spine was more lordotic than before surgery in both groups. Early surgery-related complications, including transient neurological complications, occurred in 6 patients in the 2-level PLIF group (30.0%) and 11 patients in the 1-level PLIF group (12.0%). Symptomatic adjacent-segment disease was found in 4 patients in the 2-level PLIF group (20.0%) and 10 patients in the 1-level PLIF group (10.9%). Conclusions The clinical outcome of 2-level PLIF for 2-level lumbar DS was satisfactory, although surgery-related complications including symptomatic adjacent-segment disease were not negligible.

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“Comparison of Adjacent Segment Degeneration After Non-Rigid Fixation System and Posterior Lumbar Interbody Fusion for Single-Level Lumbar Disc Herniation: A New Method of MRI Analysis of Lumbar Nucleus Pulposus Volumen”

Journal of Investigative Surgery ◽

10.1080/08941939.2018.1451576 ◽

2018 ◽

Vol 32 (5) ◽

pp. 454-455

Author(s):

Máximo-Alberto Díez-Ulloa

Keyword(s):

Nucleus Pulposus ◽

Lumbar Disc Herniation ◽

Interbody Fusion ◽

Lumbar Disc ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Rigid Fixation ◽

Lumbar Interbody Fusion ◽

Fixation System

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Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis

PLoS ONE ◽

10.1371/journal.pone.0166452 ◽

2016 ◽

Vol 11 (11) ◽

pp. e0166452 ◽

Cited By ~ 10

Author(s):

Yun-Peng Huang ◽

Cheng-Fei Du ◽

Cheng-Kung Cheng ◽

Zheng-Cheng Zhong ◽

Xuan-Wei Chen ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment Disease ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Element Analysis

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Repeated adjacent-segment degeneration after posterior lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2014.2.spine13800 ◽

2014 ◽

Vol 20 (5) ◽

pp. 538-541 ◽

Cited By ~ 10

Author(s):

Shinya Okuda ◽

Takenori Oda ◽

Ryoji Yamasaki ◽

Takafumi Maeno ◽

Motoki Iwasaki

Keyword(s):

Interbody Fusion ◽

Degenerative Spondylolisthesis ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment Degeneration ◽

Long Term Results ◽

Sacral Slope ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Primary Operation ◽

The Third

One of the most important sequelae affecting long-term results is adjacent-segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF). Although several reports have described the incidence rate, there have been no reports of repeated ASD. The purpose of this report was to describe 1 case of repeated ASD after PLIF. A 62-year-old woman with L-4 degenerative spondylolisthesis underwent PLIF at L4–5. At the second operation, L3–4 PLIF was performed for L-3 degenerative spondylolisthesis 6 years after the primary operation. At the third operation, L2–3 PLIF was performed for L-2 degenerative spondylolisthesis 1.5 years after the primary operation. Vertebral collapse of L-1 was detected 1 year after the third operation, and the collapse had progressed. At the fourth operation, 3 years after the third operation, vertebral column resection of L-1 and replacement of titanium mesh cages with pedicle screw fixation between T-4 and L-5 was performed. Although the patient's symptoms resolved after each operation, the time between surgeries shortened. The sacral slope decreased gradually although each PLIF achieved local lordosis at the fused segment.

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Does Atherosclerosis Have Negative Impacts on Early Adjacent Segment Degeneration After Posterior Lumbar Interbody Fusion?

Global Spine Journal ◽

10.1177/2192568220919370 ◽

2020 ◽

pp. 219256822091937

Author(s):

Hironobu Sakaura ◽

Daisuke Ikegami ◽

Takahito Fujimori ◽

Tsuyoshi Sugiura ◽

Yoshihiro Mukai ◽

...

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Surrogate Marker ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Significant Difference ◽

Degenerative Lumbar Spondylolisthesis ◽

Negative Impacts

Study Design: Retrospective study. Objective: To examine whether atherosclerosis has negative impacts on early adjacent segment degeneration (ASD) after posterior lumbar interbody fusion using traditional trajectory pedicle screw fixation (TT-PLIF). Methods: The subjects were 77 patients who underwent single-level TT-PLIF for degenerative lumbar spondylolisthesis. Using dynamic lateral radiographs of the lumbar spine before surgery and at 3 years postoperatively, early radiological ASD (R-ASD) was examined. Early symptomatic ASD (S-ASD) was diagnosed when neurologic symptoms deteriorated during postoperative 3-year follow-up and the responsible lesions adjacent to the fused segment were also confirmed on magnetic resonance imaging. According to the scoring system by Kauppila et al, the abdominal aortic calcification score (AAC score: a surrogate marker of systemic atherosclerosis) was assessed using preoperative lateral radiographs of the lumbar spine. Results: The incidence of early R-ASD was 41.6% at the suprajacent segment and 8.3% at the subjacent segment, respectively. Patients with R-ASD had significantly higher AAC score than those without R-ASD. The incidence of early S-ASD was 3.9% at the suprajacent segment and 1.4% at the subjacent segment, respectively. Patients with S-ASD had higher AAC score than those without S-ASD, although there was no significant difference. Conclusions: At 3 years after surgery, the advanced AAC had significantly negative impacts on early R-ASD after TT-PLIF. This result indicates that impaired blood flow due to atherosclerosis can aggravate degenerative changes at the adjacent segments of the lumbar spine after PLIF.

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