Revision Surgery for Adjacent Segment Degeneration after Fusion for Lumbar Spondylolisthesis

Spine ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ping-Guo Duan ◽  
Praveen V. Mummaneni ◽  
Sigurd H. Berven ◽  
Rory Mayer ◽  
Hui-Bing Ruan ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Spondylolisthesis

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

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.

scholarly journals Preliminary study of the use of a CBT screw to treat lumbar adjacent segment degeneration

2019 ◽  
Author(s):  
Yonghui Zhao ◽  
Jinlong Liang ◽  
Haotian Luo ◽  
Yulong Ma ◽  
Taibang Chen ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Success Rate ◽  
Revision Surgery ◽  
Three Dimensional ◽  
Lumbar Vertebra ◽  
Reference Value ◽  
Adjacent Segment Degeneration ◽  
Screw Placement ◽  
Adjacent Segment ◽  
Success Rates

Abstract Objective: To investigate the feasibility of using the cortical bone trajectory (CBT) screw in revision surgery for lumbar adjacent segment degeneration (LASD) and to provide a reference for clinical practice.Methods:The computed tomography (CT) scans of the lumbar spine of 40 patients in our hospital were used. Three-dimensional (3D) reconstruction was performed using Mimics 19.0 software, screws with appropriate sizes were selected for the L1 to L5 vertebral segments, and the traditional pedicle (TP) screws were placed using the standard method. After the completion of screw placement, the simulated placement of CBT screws with appropriate sizes was performed separately. During screw placement, the site and the direction were adjusted accordingly to complete the screw placement as much as possible. Under the premise of safe and feasible placement, penetration of the screw through the CBT and overlap between the TP and CBT screws should be avoided. If these requirements are met, screw placement is considered successful. Otherwise, the screw placement is considered failed. After all simulated screw placements were complete, the success rate of the screw placement in each segment of the lumbar vertebra was calculated from the statistical results. Finally, the pedicle trajectory reference width (TRW) was used for grouping to investigate the correlation between the TRW and sucess rate of screw placement. Results: Four hundred simulated screw placements (80 in each pedicle) were performed in the L1-L5 pedicles. The overall success rate of CBT screw placement in the lumbar spine was 57.00%. The success rates in the L1 to L5 segments were 47.50%, 62.50%, 57.50%, 70.00%, and 47.50%, respectively. The success rate in L4 was greater than in L2 and L3, while the lowest success rates were observed in L1 and L5. The groups were established based on the TRW. The success rate of CBT screw placement increased as the TRW increased.Conclusions: CBT screws are not suitable treatments for all cases of LASD. The success rate of screw placement varies in different lumbar segments. A preoperative measurement of TRW has important reference value for evaluating the feasibility of CBT screw placement in revision surgery for LASD.

Comparison of anterior- and posterior-approach instrumented lumbar interbody fusion for spondylolisthesis

2007 ◽  
Vol 7 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Jun-Hong Min ◽  
Jee-Soo Jang ◽  
Sang-Ho Lee
Keyword(s):  
Clinical Outcomes ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Clinical Success ◽  
Japanese Orthopaedic Association ◽  
Reduction Rate ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Lumbar Spondylolisthesis

Object The purpose of this study was to compare the imaging and clinical outcomes obtained in patients with lumbar spondylolisthesis who have undergone either instrumented anterior lumbar interbody fusion (ALIF) or instrumented posterior LIF (PLIF), especially with regard to the development of adjacent-segment degeneration (ASD). Methods Forty-eight patients with preoperative spondylolisthesis and minimal ASD who underwent instrumented L4–5 fusion were divided into two groups according to the surgical approach. After ensuring the two groups' comparability, the following variables were evaluated: postoperative segmental and lumbar lordosis, postoperative percentage of vertebral slippage, reduction rate, incidence of ASD, and clinical outcomes. Results Adjacent-segment degeneration was found in 44.0% of the patients in the ALIF group and in 82.6% of those in the PLIF group (p = 0.008). Clinical success rates were 92.0 and 87.0% in the ALIF and PLIF groups, respectively. There were no statistically significant intergroup differences in the postoperative segmental and lumbar lordosis, postoperative percentage of slippage, reduction rate, Japanese Orthopaedic Association score, and success rate. Conclusions Both ALIF and PLIF can produce good outcomes in treating lumbar spondylolisthesis, but ALIF is more advantageous in preventing the development of ASD.

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

2014 ◽  
Vol 23 (S6) ◽  
pp. 693-698 ◽  
Author(s):  
Alberto Di Martino ◽  
Carlo Cosimo Quattrocchi ◽  
Laura Scarciolla ◽  
Nicola Papapietro ◽  
Bruno Beomonte Zobel ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Fusion Analysis

scholarly journals Feasibility of cortical bone trajectory screws for bridging fixation in revision surgery for lumbar adjacent segment degeneration

Medicine ◽  
2021 ◽  
Vol 100 (28) ◽  
pp. e26666
Author(s):  
Long Wang ◽  
Yong-Hui Zhao ◽  
Xing-Bo Cai ◽  
Jin-Long Liang ◽  
Hao-Tian Luo ◽  
...  
Keyword(s):  
Cortical Bone ◽  
Revision Surgery ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Cortical Bone Trajectory

scholarly journals A Minimally Invasive Technique Using Cortical Bone Trajectory Screws Assisted by 3D-Printed Navigation Templates in Lumbar Adjacent Segment Degeneration

2021 ◽  
Author(s):  
Kun He ◽  
Chunke Dong ◽  
Hongyu Wei ◽  
Feng Yang ◽  
Haoning Ma ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Cortical Bone ◽  
Clinical Efficacy ◽  
Revision Surgery ◽  
Operation Time ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
3D Printed

Abstract Background: Revision surgery of adjacent segment degeneration (ASD) commonly need to expose and remove the original fixation. In order to minimize the trauma, reduce the operation time and blood loss, we introduce a minimally invasive lumbar revision technique using cortical bone trajectory (CBT) screws assisted by three-dimensional(3D) printed navigation templates.Methods: From April 2017 to October 2019, 18 patients with ASD underwent revision surgery with CBT screws assisted by 3D-printed templates in our hospital. All the operation data, including operation time, blood loss, incision length were recorded. We evaluated the clinical efficacy using the visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. X-ray and Computed Tomography (CT) scans were used to evaluate the stability of CBT screws fixation, the accuracy of screws, and the fusion rate.Results: The mean follow-up was 22.4±4.7 months (12-31m), the VAS, ODI, and JOA score were analyzed by SPSS 21.0 and showed significant improvement at 2-weeks and the last follow-up compared with preoperative data(P<0.05). 76 CBT screws were inserted with navigation templates, 2 screws were Grade B, other screws were all Grade 0 or A. Changes of intervertebral height showed good stability of CBT screws fixation(P>0.05). All the patients had satisfactory fusion results.Conclusion: Revision surgery of ASD with CBT screws assisted by 3D-printed navigation templates has satisfactory clinical efficacy with advantages of the short operation time, small incision, and less blood loss.

scholarly journals Revision Surgery for Symptomatic Adjacent Segment Disc Degeneration after Initial Anterior Cervical Fusion: Is ROI-C Better than Plate-Cage Construct?

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Junjie Niu ◽  
Dawei Song ◽  
Yijie Liu ◽  
Heng Wang ◽  
Cheng Huang ◽  
...  
Keyword(s):  
Blood Loss ◽  
Disc Degeneration ◽  
Revision Surgery ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Initial Surgery ◽  
Cervical Surgery ◽  
Cage Group

The optimal revision surgical strategy for patients who develop symptomatic adjacent segment disc degeneration (ASD) is controversial. The risks of intraoperative complications, especially the incidence of dysphagia, were relatively high for revision surgeries. This study was aimed at comparing the efficacy of revision surgery using a traditional plate-cage construct and zero-profile anchored spacer (ROI-C) device in treating symptomatic ASD after initial anterior cervical discectomy and fusion (ACDF) surgery. Forty-two patients who developed symptomatic ASD were retrospectively analyzed and classified into two groups (plate-cage group and ROI-C group). The clinical and radiological results were compared. We further evaluated the complication of dysphagia and dysphagia-related risk factors in these patients. The JOA and NDI scores, C2-7 lordotic angle, and intervertebral space height were significantly improved after revision surgery in both groups. The operative time and intraoperative blood loss both significantly decreased in the ROI-C group. The incidence of postoperative dysphagia was much lower in the ROI-C group than in the plate-cage group (18.75% vs. 57.69%; P = 0.01 ). The presence of dysphagia after initial surgery ( P = 0.003 ) and revision surgery type ( P = 0.01 ) was significantly related to the presence of dysphagia after revision surgery. These results indicated that both the plate-cage construct and ROI-C are effective in treating symptomatic ASD. However, compared with the traditional plate-cage construct, ROI-C with less operative time, less blood loss, and lower incidence of dysphagia is more suitable. Furthermore, ROI-C should preferably be used for patients who present with dysphagia after initial cervical surgery. This study will provide clinical guidance for spinal surgeons to choose the zero-profile device in treating specific and complicated cases, which will significantly improve the therapeutic efficacy of symptomatic adjacent segment degeneration.

Case Example: Adjacent Segment Disease: What Is It, and How Is It Rated?

2011 ◽  
Vol 16 (2) ◽  
pp. 8-9
Author(s):  
Marjorie Eskay-Auerbach
Keyword(s):  
Clinical Symptoms ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Disc Space Narrowing ◽  
Disc Disease ◽  
Disc Space ◽  
Radiographic Findings ◽  
Asymptomatic Patients

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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