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

Abstract Study design A meta-analysis. Objective We performed a meta-analysis to explore the incidence and risk factors of adjacent segment degeneration (ASD) after posterior lumbar fusion surgery. Methods An extensive search of the literature was performed in English database of PubMed, Embase, and Cochrane Library, and Chinese database of CNKI and WANFANG (up to May 2020). We collected factors including demographic data, surgical factor, and sagittal parameters. Data analysis was conducted with RevMan 5.3 and STATA 12.0. Results Finally, 19 studies were included in the final analysis. In our study, the rate of ASD after posterior lumbar fusion surgery was 18.6% (540 of 2896). Our data also showed that mean age, body mass index (BMI), the history of smoking and hypertension, preoperative adjacent disc degeneration, long-segment fusion, preoperative superior facet violation, high lumbosacral joint angle, pre- and post-operative L1-S1 sagittal vertical axis (SVA), post-operative lumbar lordosis (LL), and preoperative pelvic incidence (PI) were associated with the development of ASD. However, gender, history of diabetes, bone mineral density (BMD), preoperative Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA), the type of fusion (PLIF vs TLIF), type of bone graft (auto- vs allograft), fusion to S1(vs non-fusion to S1), diagnose (lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis), preoperative pelvic tilt (PT), LL and sacral slope (SS), post-operative SS, PT and PI were not associated with the development of ASD. Conclusions In our study, many factors were correlated with the risk of ASD after posterior lumbar fusion surgery. We hope this article can provide a reference for spinal surgeons in treatment for lumbar degenerative diseases.

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Adjacent segment degeneration after posterior lumbar fusion: An analysis of possible risk factors

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2016.02.004 ◽

2016 ◽

Vol 143 ◽

pp. 15-18 ◽

Cited By ~ 13

Author(s):

Amir Abbas Ghasemi

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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The Clinical Characteristics and Risk Factors for the Adjacent Segment Degeneration in Instrumented Lumbar Fusion

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0b013e318142b960 ◽

2008 ◽

Vol 21 (5) ◽

pp. 305-309 ◽

Cited By ~ 61

Author(s):

Jun-Hong Min ◽

Jee-Soo Jang ◽

Byung joo Jung ◽

Ho Yeon Lee ◽

Won-Chul Choi ◽

...

Keyword(s):

Risk Factors ◽

Clinical Characteristics ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment

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Survival Rates and Risk Factors for Cephalad and L5-S1 Adjacent Segment Degeneration after L5 Floating Lumbar Fusion : A Minimum 2-Year Follow-Up

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2015.57.2.108 ◽

2015 ◽

Vol 57 (2) ◽

pp. 108 ◽

Cited By ~ 1

Author(s):

Young-Seok Lee ◽

Young-Baeg Kim ◽

Seung-Won Park

Keyword(s):

Risk Factors ◽

Lumbar Fusion ◽

Survival Rates ◽

Adjacent Segment Degeneration ◽

Adjacent Segment

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

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2011.marapr02 ◽

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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TELD with limited foraminoplasty has potential biomechanical advantages over TELD with large annuloplasty: an in-silico study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04504-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jingchi Li ◽

Chen Xu ◽

Xiaoyu Zhang ◽

Zhipeng Xi ◽

Mengnan Liu ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Poor Prognosis ◽

Adjacent Segment Degeneration ◽

Iatrogenic Injury ◽

Adjacent Segment ◽

Fe Model ◽

High Grade ◽

Endoscopic Lumbar Discectomy ◽

Adjacent Segments

Abstract Background Facetectomy, an important procedure in the in–out and out–in techniques of transforaminal endoscopic lumbar discectomy (TELD), is related to the deterioration of the postoperative biomechanical environment and poor prognosis. Facetectomy may be avoided in TELD with large annuloplasty, but iatrogenic injury of the annulus and a high grade of nucleotomy have been reported as risk factors influencing poor prognosis. These risk factors may be alleviated in TELD with limited foraminoplasty, and the grade of facetectomy in this surgery can be reduced by using an endoscopic dynamic drill. Methods An intact lumbo-sacral finite element (FE) model and the corresponding model with adjacent segment degeneration were constructed and validated to evaluate the risk of biomechanical deterioration and related postoperative complications of TELD with large annuloplasty and TELD with limited foraminoplasty. Changes in various biomechanical indicators were then computed to evaluate the risk of postoperative complications in the surgical segment. Results Compared with the intact FE models, the model of TELD with limited foraminoplasty demonstrated slight biomechanical deterioration, whereas the model of TELD with large annuloplasty revealed obvious biomechanical deterioration. Degenerative changes in adjacent segments magnified, rather than altered, the overall trends of biomechanical change. Conclusions TELD with limited foraminoplasty presents potential biomechanical advantages over TELD with large annuloplasty. Iatrogenic injury of the annulus and a high grade of nucleotomy are risk factors for postoperative biomechanical deterioration and complications of the surgical segment.

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Demographic, Surgical, and Radiographic Risk Factors for Symptomatic Adjacent Segment Disease After Lumbar Fusion

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.20.00408 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Kenney K.L. Lau ◽

Dino Samartzis ◽

Nicholas S.C. To ◽

Garrett K. Harada ◽

Howard S. An ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Fusion ◽

Adjacent Segment Disease ◽

Adjacent Segment

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Differences in standing and sitting spinopelvic sagittal alignment for patients with posterior lumbar fusion: important considerations for the changes of unfused adjacent segments lordosis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03777-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Zhuoran Sun ◽

Siyu Zhou ◽

Wei Wang ◽

Da Zou ◽

Weishi Li

Keyword(s):

Sagittal Alignment ◽

Lumbar Fusion ◽

Linear Regression Analysis ◽

Posterior Lumbar Interbody Fusion ◽

Sagittal Profile ◽

Adjacent Segment ◽

Sitting Position ◽

Lumbosacral Fusion ◽

Posterior Lumbar Fusion

Abstract Objective This study aimed to describe the changes in spinopelvic sagittal alignment in the sitting position after posterior lumbar fusion, and to identify the factors influencing unfused adjacent segment lordosis. Methods Consecutive patients with lumbar degenerative disease who underwent posterior lumbar interbody fusion between December 2010 and April 2012 were recruited. Lateral full spine radiographs were obtained in the standing, erect sitting, and natural sitting positions. Spinopelvic parameters were measured preoperatively and at the final follow-up. Results The data of 63 patients were analyzed in this study. The average age was 61.6 ± 11.0 years. When changing from standing to sitting at the final follow-up, all spinopelvic sagittal parameters with the exceptions of pelvic incidence and thoracic kyphosis were significantly altered. The most noticeable changes occurred in the natural sitting position, with the spine slumped toward achieving a C-shaped sagittal profile. Multiple linear regression analysis revealed that when changing to a natural sitting position, age and fusion levels reflected the changes in lumbar lordosis (ΔLL), age and lumbosacral fusion reflected the changes in upper residual lordosis (ΔURL). Conclusion The most noticeable changes in spinopelvic sagittal alignment occurred in the natural sitting position after lumbar fusion. Age, fusion levels, and lumbosacral fusion significantly influenced the differences in LL and URL between the standing and natural sitting position. These characteristics should be fully considered when planning spinal realignment surgery and investigating the etiological factors of junctional complications.

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