The Efficacy of Lumbar Hybrid Stabilization Using the DIAM to Delay Adjacent Segment Degeneration: An Intervention Comparison Study With a Minimum 2-Year Follow-up

2013 ◽  
Vol 73 (2) ◽  
pp. ons224-ons232 ◽  
Author(s):  
Chang-Hyun Lee ◽  
Seung-Jae Hyun ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng ◽  
Sang Hoon Yoon ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Comparison Study ◽  
Hybrid Surgery ◽  
Long Term Outcome ◽  
Hybrid Stabilization ◽  
Surgical Methods ◽  
Facet Joint Degeneration ◽  
Hybrid Group

Abstract BACKGROUND: Although posterior lumbar interbody fusion (PLIF) has a successful fusion rate, the long-term outcome of PLIF is occasionally below expectations because of adjacent segment degeneration (ASD). OBJECTIVE: To evaluate the ability of hybrid stabilization using DIAM (Device for Interspinous Assisted Motion) to delay ASD. METHODS: An intervention comparison study of 75 patients (hybrid, 25; PLIF, 50) was performed. The indications for hybrid stabilization were facet joint degeneration, Pfirrmann grade II to III, and stenosis at the rostral adjacent segment. The PLIF group consisted of patients matched for age, sex, and fusion. The hybrid stabilization procedure included traditional PLIF and DIAM installation at a superior adjacent segment. The outcomes were analyzed with a linear mixed model analysis. Conditional logistic regression was performed to calculate the odds ratio for the association of surgical methods. RESULTS: The hybrid group (24%) revealed fewer ASDs than the PLIF group (48%). Among ASDs, spondylolisthesis occurred more frequently in the PLIF group than the hybrid group. Hybrid surgery was significantly associated with ASD; the odds ratio for hybrid surgery was 0.28 compared with PLIF. Foraminal height of the PLIF group decreased more than the hybrid group (P = .01). Segmental mobility showed a greater increase in the PLIF group than the hybrid group (P = .04). However, the clinical outcomes did not show significant differences between the groups. CONCLUSION: Hybrid stabilization with DIAM and pedicle screws can be used for patients with facet degeneration at adjacent segments but should be further investigated.

The Efficacy of Lumbar Hybrid Stabilization Using the DIAM™ to Delay Adjacent Segment Degeneration

Neurosurgery ◽  
2013 ◽  
pp. 1 ◽  
Author(s):  
Chang-Hyun Lee ◽  
Seung-Jae Hyun ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng ◽  
Sang hoon Yoon ◽  
...  
Keyword(s):  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Hybrid Stabilization

Higher Risk of Adjacent Segment Degeneration After Floating Fusions: Long-Term Outcome After Low Lumbar Spine Fusions

2008 ◽  
Vol 21 (2) ◽  
pp. 79-85 ◽  
Author(s):  
Alexander Carl Disch ◽  
Werner Schmoelz ◽  
Georg Matziolis ◽  
Sascha V. Schneider ◽  
Christian Knop ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Hybrid Strategy of Cervical Artificial Disc and Intervertebral Cage – Biomechanical Effects on the Adjacent Tissues and Implants

2020 ◽  
Author(s):  
Tzu-Tsao Chung ◽  
Dueng-Yuan Hueng ◽  
Chi-Pin Hsu ◽  
Chun-Ming Chen ◽  
Shang-Chih Lin
Keyword(s):  
Element Model ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Peek Cage ◽  
Artificial Disc ◽  
Hybrid Surgery ◽  
Hybrid Strategy ◽  
Intervertebral Cage ◽  
Adjacent Segments ◽  
Nonlinear Finite Element Model

Abstract Background: Adjacent segment degeneration (ASD) is a concern in multi-level ACDF surgery. Hybrid surgery with C-ADR and ACDF are an alternative treatment to reduce the level of increased rigidity, but biomechanical differences between strategies using one C-ADR and two ACDFs have not been thoroughly investigated.Methods: To evaluate the placement-related effects of using one cervical artificial disc replacement (C-ADR) and two anterior cervical discectomy and fusion (ACDF) on tissue responses and implant behavior. A nonlinear finite element model from the C2 to the T1 vertebrae was developed. Ligament interconnection, follower loads, and weight compression were used to simulate cervical flexion. Within the C4-C7 segments, two placements of one C-ADR and two ACDFs were arranged: PAP (peek cage, artificial disc, and peek cage) and APP.Results: Both PAP and APP consistently induced kinematic and mechanical redistribution to adjacent segments. The C-ADR served as a buffer of the compensated motion and stress from the ACDF segments. The motion and stress of the cranial C2-C3 and C3-C4 segments were greater for the PAP than the APP constructs. However, the caudal C7-T1 segment of the APP construct was more flexed and stressed. Serially stacked cages of the APP placement increased bone-cage stresses, potentially inducing subsidence and loosening. The sandwiched C-ADR of the PAP construct accommodated the compensated motion and stress from the adjacent ACDFs more than the APP construct.Conclusions: The PAP and APP placements cause more severe ASD progression at the cranial and caudal segments, respectively. The PAP placement is preferred for concerns regarding ACDF and postoperative degeneration of caudal segments. The APP placement is recommended when C-ADR failure and ASD progression are considered.

scholarly journals The Incidence of Adjacent Segment Degeneration after the Use of a Versatile Dynamic Hybrid Stabilization Device in Lumbar Stenosis: Results of a 5–8-Year Follow-up

2018 ◽  
Vol 12 (2) ◽  
pp. 263-271 ◽  
Author(s):  
Mauro Dobran ◽  
Davide Nasi ◽  
Domenico Paolo Esposito ◽  
Maurizio Gladi ◽  
Massimo Scerrati ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Hybrid Fixation ◽  
Hybrid Stabilization ◽  
Long Term Follow Up ◽  
Lumbar Spinal

<sec><title>Study Design</title><p>Retrospective study with long-term follow-up.</p></sec><sec><title>Purpose</title><p>To evaluate the long-term incidence of adjacent segment degeneration (ASD) and clinical outcomes in a consecutive series of patients who underwent spinal decompression associated with dynamic or hybrid stabilization with a Flex+TM stabilization system (SpineVision, Antony, France) for lumbar spinal stenosis.</p></sec><sec><title>Overview of Literature</title><p>The incidence of ASD and clinical outcomes following dynamic or hybrid stabilization with the Flex+TM system used for lumbar spinal stenosis have not been well investigated.</p></sec><sec><title>Methods</title><p>Twenty-one patients with lumbar stenosis and probable post-decompressive spinal instability underwent decompressive laminectomy followed by spinal stabilization using the Flex+TM stabilization system. The indication for a mono-level dynamic stabilization was a preoperative magnetic resonance imaging (MRI) demonstrating evidence of severe disc disease associated with severe spinal stenosis. The hybrid stabilization (rigid-dynamic) system was used for multilevel laminectomies with associated initial degenerative scoliosis, first-grade spondylolisthesis, or rostral pathology.</p></sec><sec><title>Results</title><p>The improvement in Visual Analog Scale and Oswestry Disability Index scores at follow-up were statistically significant (<italic>p</italic>&lt;0.0001 and <italic>p</italic>&lt;0.0001, respectively). At the 5–8-year follow-up, clinical examination, MRI, and X-ray findings showed an ASD complication with pain and disability in one of 21 patients. The clinical outcomes were similar in patients treated with dynamic or hybrid fixation.</p></sec><sec><title>Conclusions</title><p>Patients treated with laminectomy and Flex+TM stabilization presented a satisfactory clinical outcome after 5–8 years of follow-up, and ASD incidence in our series was 4.76% (one patient out of 21). We are aware that this is a small series, but our long-term follow-up may be sufficient to contribute to the expanding body of literature on the development of symptomatic ASD associated with dynamic or hybrid fixation.</p></sec>

scholarly journals Biomechanical effects of hybrid stabilization on the risk of proximal adjacent-segment degeneration following lumbar spinal fusion using an interspinous device or a pedicle screw–based dynamic fixator

2017 ◽  
Vol 27 (6) ◽  
pp. 643-649 ◽  
Author(s):  
Chang-Hyun Lee ◽  
Young Eun Kim ◽  
Hak Joong Lee ◽  
Dong Gyu Kim ◽  
Chi Heon Kim
Keyword(s):  
Pedicle Screw ◽  
Element Model ◽  
Adjacent Segment Degeneration ◽  
Hybrid Models ◽  
Lumbosacral Spine ◽  
Adjacent Segment ◽  
Fusion Model ◽  
Hybrid Stabilization ◽  
Interspinous Device ◽  
Flexion Extension

OBJECTIVEPedicle screw-rod–based hybrid stabilization (PH) and interspinous device–based hybrid stabilization (IH) have been proposed to prevent adjacent-segment degeneration (ASD) and their effectiveness has been reported. However, a comparative study based on sound biomechanical proof has not yet been reported. The aim of this study was to compare the biomechanical effects of IH and PH on the transition and adjacent segments.METHODSA validated finite element model of the normal lumbosacral spine was used. Based on the normal model, a rigid fusion model was immobilized at the L4–5 level by a rigid fixator. The DIAM or NFlex model was added on the L3–4 segment of the fusion model to construct the IH and PH models, respectively. The developed models simulated 4 different loading directions using the hybrid loading protocol.RESULTSCompared with the intact case, fusion on L4–5 produced 18.8%, 9.3%, 11.7%, and 13.7% increments in motion at L3–4 under flexion, extension, lateral bending, and axial rotation, respectively. Additional instrumentation at L3–4 (transition segment) in hybrid models reduced motion changes at this level. The IH model showed 8.4%, −33.9%, 6.9%, and 2.0% change in motion at the segment, whereas the PH model showed −30.4%, −26.7%, −23.0%, and 12.9%. At L2–3 (adjacent segment), the PH model showed 14.3%, 3.4%, 15.0%, and 0.8% of motion increment compared with the motion in the IH model. Both hybrid models showed decreased intradiscal pressure (IDP) at the transition segment compared with the fusion model, but the pressure at L2–3 (adjacent segment) increased in all loading directions except under extension.CONCLUSIONSBoth IH and PH models limited excessive motion and IDP at the transition segment compared with the fusion model. At the segment adjacent to the transition level, PH induced higher stress than IH model. Such differences may eventually influence the likelihood of ASD.

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.

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

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.

scholarly journals Stand-Alone Posterior Expandable Cage Technique for Adjacent Segment Degeneration with Lumbar Spinal Canal Stenosis: A Retrospective Case Series

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 237
Author(s):  
Woo-Jin Choi ◽  
Seung-Kook Kim ◽  
Manhal Alaraj ◽  
Hyeun-Sung Kim ◽  
Su-Chan Lee
Keyword(s):  
Sagittal Balance ◽  
Spinal Canal ◽  
Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Spinal Canal Stenosis ◽  
Adjacent Segment ◽  
Lumbar Spinal Canal Stenosis ◽  
Canal Stenosis ◽  
Lumbar Spinal ◽  
Expandable Cages

Background and Objectives: Symptomatic adjacent segment degeneration (ASD) with lumbar spinal canal stenosis (LSCS) is a common complication after spinal intervention, particularly interbody fusion. Stand-alone posterior expandable cages enable interbody fusion with preservation of the previous operation site, and screw-related complications are avoided. Thus, the aim of this study was to investigate the clinicoradiologic outcomes of stand-alone posterior expandable cages for ASD with LSCS. Materials and Methods: Patients with persistent neurologic symptoms and radiologically confirmed ASD with LSCS were evaluated between January 2011 and December 2016. The five-year follow-up data were used to evaluate the long-term outcomes. The radiologic parameters for sagittal balance, pain control (visual analogue scale), disability (Oswestry Disability Index), and early (peri-operative) and late (implant) complications were evaluated. Results: The data of 19 patients with stand-alone posterior expandable cages were evaluated. Local factors, such as intervertebral and foraminal heights, were significantly corrected (p < 0.01 and p < 0.01, respectively), and revision was not reported. The pain level (p < 0.01) and disability rate (p < 0.01) significantly improved, and the early complication rate was low (n = 2, 10.52%). However, lumbar lordosis (p = 0.62) and sagittal balance (p = 0.80) did not significantly improve. Furthermore, the rates of subsidence (n = 4, 21.05%) and retropulsion (n = 3, 15.79%) were high. Conclusions: A stand-alone expandable cage technique should only be considered for older adults and patients with previous extensive fusion. Although this technique is less invasive, improves the local radiologic factors, and yields favorable clinical outcomes with low revision rates, it does not improve the sagittal balance. For more widespread application, the strength of the cage material and high subsidence rates should be improved.

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