Adjacent Segment Degeneration After Lumbar Interbody Fusion With Percutaneous Pedicle Screw Fixation for Adult Low-Grade Isthmic Spondylolisthesis: Minimum 3 Years of Follow-up

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. 1600-1608 ◽  
Author(s):  
Jun Seok Bae ◽  
Sang-Ho Lee ◽  
Jin-Sung Kim ◽  
Byungjoo Jung ◽  
Gun Choi
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Significant Risk ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Low Grade ◽  
Lumbar Interbody Fusion ◽  
Isthmic Spondylolisthesis

Abstract BACKGROUND: Although favorable clinical outcomes have been reported for instrumented lumbar interbody fusion (LIF), adjacent segment degeneration (ASD) has been reported as a long-term complication after LIF. OBJECTIVE: To investigate ASD after instrumented LIF performed at a single level and only for the homogeneous disease of adult low-grade isthmic spondylolisthesis. METHODS: A total of 128 patients who had undergone LIF for the treatment of adult low-grade isthmic spondylolisthesis involving the lower lumbar spine at our institution between February 2001 and December 2004 were retrospectively reviewed by chart review and telephone survey. Of them, 103 patients with a minimum of a 36-month follow-up period were enrolled in this study. The mean age was 48.5 years. The average follow-up period was 59 months. Clinical and radiological data related to segmental lordosis (SL), whole lumbar lordosis, sacral slope, pelvic tilt, pelvic incidence, and L1 axis S1 distance were analyzed to identify significant risk factors for ASD. RESULTS: The overall incidence of ASD was 10.6% (11/103). The incidences of radiographic and symptomatic ASD were 8.7% (9/103) and 1.9% (2/103), respectively. All patients improved clinically and functionally during the follow-up period. Postoperative SL, preoperative SL, whole lumbar lordosis, and L1 axis S1 distance were significant risk factors for ASD. Only SL was a significant risk factor for both the preoperative and postoperative states. CONCLUSION: ASD may occur at a relatively lower incidence in adult low-grade isthmic spondylolisthesis compared with other degenerative lumbar spinal diseases. SL is significantly correlated with ASD, whereas mechanical alterations caused by LIF are less likely to affect the adjacent segment. Restoration of normal SL is important for preventing ASD, and long-term follow-up is necessary.

Obesity may be associated with adjacent-segment degeneration after single-level transforaminal lumbar interbody fusion in spinopelvic-mismatched patients with a minimum 2-year follow-up

2021 ◽  
Vol 34 (1) ◽  
pp. 83-88
Author(s):  
Ping-Guo Duan ◽  
Praveen V. Mummaneni ◽  
Minghao Wang ◽  
Andrew K. Chan ◽  
Bo Li ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Inclusion Criteria ◽  
Single Level ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Surgery Rates

OBJECTIVEIn this study, the authors’ aim was to investigate whether obesity affects surgery rates for adjacent-segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis.METHODSPatients who underwent single-level TLIF for spondylolisthesis at the University of California, San Francisco, from 2006 to 2016 were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, single-level TLIF, and degenerative lumbar spondylolisthesis. Exclusion criteria were trauma, tumor, infection, multilevel fusions, non-TLIF fusions, or less than a 2-year follow-up. Patient demographic data were collected, and an analysis of spinopelvic parameters was performed. The patients were divided into two groups: mismatched, or pelvic incidence (PI) minus lumbar lordosis (LL) ≥ 10°; and balanced, or PI-LL < 10°. Within the two groups, the patients were further classified by BMI (< 30 and ≥ 30 kg/m2). Patients were then evaluated for surgery for ASD, matched by BMI and PI-LL parameters.RESULTSA total of 190 patients met inclusion criteria (72 males and 118 females, mean age 59.57 ± 12.39 years). The average follow-up was 40.21 ± 20.42 months (range 24–135 months). In total, 24 patients (12.63% of 190) underwent surgery for ASD. Within the entire cohort, 82 patients were in the mismatched group, and 108 patients were in the balanced group. Within the mismatched group, adjacent-segment surgeries occurred at the following rates: BMI < 30 kg/m2, 2.1% (1/48); and BMI ≥ 30 kg/m2, 17.6% (6/34). Significant differences were seen between patients with BMI ≥ 30 and BMI < 30 (p = 0.018). A receiver operating characteristic curve for BMI as a predictor for ASD was established, with an AUC of 0.69 (95% CI 0.49–0.90). The optimal BMI cutoff value determined by the Youden index is 29.95 (sensitivity 0.857; specificity 0.627). However, in the balanced PI-LL group (108/190 patients), there was no difference in surgery rates for ASD among the patients with different BMIs (p > 0.05).CONCLUSIONSIn patients who have a PI-LL mismatch, obesity may be associated with an increased risk of surgery for ASD after TLIF, but in obese patients without PI-LL mismatch, this association was not observed.

scholarly journals Adjacent Segment Degeneration after Posterior Lumbar Interbody Fusion: Based on Cases with a Minimum of 10 years of Follow-Up

2015 ◽  
Vol 5 (1_suppl) ◽  
pp. s-0035-1554255-s-0035-1554255
Author(s):  
Hiroaki Nakashima ◽  
Noriaki Kawakami ◽  
Taichi Tsuji ◽  
Shiro Imagama
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion

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.

scholarly journals Functional and radiological analysis of posterior lumbar interbody fusion in spondylolisthesis

2015 ◽  
Vol 1 (1) ◽  
pp. 11
Author(s):  
Ramanujam Muthu Manickam ◽  
Ganesan G. Ram ◽  
S. Sundar ◽  
A. Prakash
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Surgical Intervention ◽  
Degenerative Spondylolisthesis ◽  
Posterior Lumbar Interbody Fusion ◽  
Low Grade ◽  
Lumbar Interbody Fusion ◽  
Isthmic Spondylolisthesis ◽  
The Mean

<p class="abstract"><strong><span lang="EN-US">Background:</span></strong>Spondylolisthesis is present in 5% of the adult population with clinical evidence of low back pain. These patients are treated initially by conservative measures, failing of which surgical intervention is mandatory. Majority of patients with varying degree of slip and disability ultimately require surgical intervention. In this study we are trying to analyse the functional outcome following posterior lumbar interbody fusion in spondylolisthesis.</p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong><span lang="EN-US"> Posterior lumbar interbody fusion using pedicle screw and rods with cage was performed on 25 patients. 6 months follow-up was completed in 25 patients who were then reviewed at regular intervals. Out of the 25 patients, 17(68%) were females and 8(32%) were males. The mean age of the patients was 40.64 years. Out of 25 patients, 14 patients had listhesis at L4 – L5 level and another 11 at L5 – S1 level. 21(84%) were Isthmic variant and 4 (16%) were Degenerative spondylolisthesis.<strong></strong></span></p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong>The mean follow up period in this study of 25 patients is 19 months. Out of 25 patients, there was mean improvement of 18.96 in the Oswestry scoring index. The Visual analogue scale score showed a mean improvement of 6.48. Radiologically, the percentage of slip was decreased by a mean of 8.40%. One patient had a cage extrusion with no neurological deficit.</p><p class="abstract"><strong><span lang="EN-US">Conclusions:</span></strong>The pedicle screw with rod and cage system is easy to use and provides the anatomic restoration of the isthmus in isthmic spondylolisthesis or restoring the stability after laminectomy/discectomy in degenerative spondylolisthesis. From our study, we strongly believe that this technique is very useful in low grade degenerative and isthmic spondylolisthesis.</p>

130. Long-term Effects of Anterior Lumbar Interbody Fusion on Adjacent Segment Motion: Six-year Follow-up

2007 ◽  
Vol 7 (5) ◽  
pp. 62S-63S
Author(s):  
David Polly ◽  
J. Kenneth Burkus ◽  
Kevin Foley ◽  
Elliot H. Sanders ◽  
Jensina Warmbold
Keyword(s):  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Long Term Effects

scholarly journals Medium-term effects of Dynesys dynamic stabilization versus posterior lumbar interbody fusion for treatment of multisegmental lumbar degenerative disease

2017 ◽  
Vol 45 (5) ◽  
pp. 1562-1573 ◽  
Author(s):  
Haiting Wu ◽  
Qingjiang Pang ◽  
Guoqiang Jiang
Keyword(s):  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Degenerative Disease ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Medium Term ◽  
Lumbar Degenerative Disease ◽  
Radiographic Outcomes

Objective To compare the medium-term clinical and radiographic outcomes of Dynesys dynamic stabilization and posterior lumbar interbody fusion (PLIF) for treatment of multisegmental lumbar degenerative disease. Methods Fifty-seven patients with multisegmental lumbar degenerative disease underwent Dynesys stabilization (n = 26) or PLIF (n = 31) from December 2008 to February 2010. The mean follow-up period was 50.3 (range, 46–65) months. Clinical outcomes were evaluated using a visual analogue scale (VAS) and the Oswestry disability index (ODI). Radiographic evaluations included disc height and range of motion (ROM) of the operative segments and proximal adjacent segment on lumbar flexion-extension X-rays. The intervertebral disc signal change was defined by magnetic resonance imaging, and disc degeneration was classified by the Pfirrmann grade. Results The clinical outcomes including the VAS score and ODI were significantly improved in both groups at 3 months and the final follow-up, but the difference between the two was not significant. At the final follow-up, the disc height of stabilized segments in both groups was significantly increased; the increase was more notable in the Dynesys than PLIF group. The ROM of stabilized segments at the final follow-up decreased from 6.20° to 2.76° and 6.56° to 0.00° in the Dynesys and PLIF groups, respectively. There was no distinct change in the height of the proximal adjacent segment in the two groups. The ROM of the proximal adjacent segment in both groups increased significantly at the final follow-up; the change was significantly greater in the PLIF than Dynesys group. Only one case of adjacent segment degeneration occurred in the PLIF group, and this patient underwent a second operation. Conclusions Both Dynesys stabilization and PLIF can improve the clinical and radiographic outcomes of multisegmental lumbar degenerative disease. Compared with PLIF, Dynesys stabilization can maintain the mobility of the stabilized segments with less influence on the proximal adjacent segment and may help to prevent the occurrence of adjacent segment degeneration. Dynesys is reliable for the treatment of multisegmental lumbar degenerative disease at the medium-term follow-up.

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