Comparison of patient-specific computational models vs. clinical follow-up, for adjacent segment disc degeneration and bone remodelling after spinal fusion

Abstract Study design A retrospective, single center, case-control study was performed. Objective The present study employed patient-specific biomechanical modeling to find potential biomechanical differences after spinal fusion at L4/5 in patients with and without subsequent development of adjacent segment disease (ASD). Methods The study population comprised patients who underwent primary spinal fusion at L4/5 and were either asymptomatic during > 4 years of follow-up (CTRL; n = 18) or underwent revision surgery for ASD at L3/4 (n = 20). Landmarks were annotated on preoperative and follow-up lateral radiographs, and specific musculoskeletal models were created using a custom-built modeling pipeline. Simulated spinal muscle activation and lumbar intervertebral shear loads in unfused segments were analyzed in upright standing and forward flexion. Differences between the pre- and postoperative conditions were computed for each patient. Results The average postoperative muscle activity in the upright standing posture was 88.4% of the preoperative activity in the CTRL group (p < 0.0001), but did not significantly change from pre- to postoperatively in the ASD group (98.0%). The average shear load magnitude at the epifusional joint L3/4 during upright standing increased from pre- to postoperatively in the ASD group (+ 3.9 N, +/− 17.4 (n = 18)), but decreased in the CTRL group (− 4.6 N, +/− 23.3 (n = 20); p < 0.001). Conclusion Patient-specific biomechanical simulation revealed that spinal fusion surgery resulted in greater shear load magnitude and muscle activation and therefore greater forces at the epifusional segment in those with ASD compared with those without ASD. This is a first report of patient-specific disc load and muscle force calculation with predictive merits for ASD.

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The Effects of Spinal Fusion on Lumbar Disc Degeneration in Patients with Adolescent Idiopathic Scoliosis: A Minimum 10-Year Follow-Up

Spine Deformity ◽

10.1016/j.jspd.2015.04.001 ◽

2015 ◽

Vol 3 (5) ◽

pp. 462-468 ◽

Cited By ~ 18

Author(s):

Ayato Nohara ◽

Noriaki Kawakami ◽

Kenji Seki ◽

Taichi Tsuji ◽

Tetsuya Ohara ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Disc Degeneration ◽

Lumbar Disc ◽

Lumbar Disc Degeneration

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Impact of patient-specific factors and spinopelvic alignment on the development of adjacent segment degeneration after short-segment lumbar fusion

10.21203/rs.3.rs-898513/v1 ◽

2021 ◽

Author(s):

László Kiss ◽

Zsolt Szövérfi ◽

Ferenc Bereczki ◽

Péter Endre Éltes ◽

Balázs Szöllösi ◽

...

Keyword(s):

Disc Degeneration ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Patient Specific ◽

Adjacent Segment ◽

Short Segment ◽

Adjacent Disc ◽

Disc Bulge ◽

Specific Factors

Abstract Objectives: The main purpose of the study was to analyse the different demographical, morphological, and surgery-related parameters influencing the development or progress of degeneration in adjacent segments after routine, short-segment lumbar fusions.Summary of Background data: Adjacent segment degeneration (ASD) considered as a major long-term complication after lumbar fusions. Possible risk factors are related to the patients’ demographics, spinopelvic anatomy or preoperative lumbar intervertebral disc conditions. The current literature lacks of well-designed prospective studies focusing on the multidimensional nature of the condition.Methods: A prospective cohort of 100 patients who underwent one- or two-level lumbar transforaminal interbody fusions due to lumbar degenerative pathology was conducted. Demographical, radiological findings (spinopelvic parameters, adjacent segmental radiological as well as magnetic resonance imaging (MRI) features) and long-term outcome data (5-year) were analysed to identify factors associated with ASD. Results: ASD patients showed higher level of pain (p=0.004) and disability (p=0.020) at follow-up. In univariate analysis, older age, upper-level lumbar fusion (p=0.007), lower L4-S1 lordosis (p=0.039), PI-LL mismatch (p=0.021), Pfirrmann grade III or higher disc degeneration (p=0.002) and the presence of disc bulge/herniation were (p=0.007) associated with ASD. Final result of multivariate analysis showed major degenerative sign (disc degeneration and/or disc bulge) as a risk factor (OR 3.85, CI 1.43-10.37, p=0.006).Conclusion: By examining the role of different patient- and procedure-specific factors, we found that preoperative major degenerative signs at the adjacent segment increase the risk of ASD causing significantly worse outcome after short-segment lumbar fusion. Adjacent disc conditions should be considered carefully during surgical planning.

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Predicting factors of adjacent segment degeneration after long-segment spinal fusion: spinopelvic parameters analysis

10.21203/rs.2.18590/v2 ◽

2020 ◽

Author(s):

Ping-Yeh Chiu ◽

Fu-Cheng Kao ◽

Wen-Jer Chen ◽

Chia-Wei Yu ◽

Chi-Chien Niu ◽

...

Keyword(s):

Spinal Fusion ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Control Group ◽

Sacral Slope ◽

Adjacent Segment ◽

Spinopelvic Parameters ◽

Significant Difference ◽

Adjacent Disc

Abstract Background We investigated whether spinopelvic parameters are important prognostic factors causing adjacent segment degeneration (ASD) after long instrumented spinal fusion for degenerative spinal disease. Methods This uncontrolled, randomized, single arm retrospective study included patients who underwent long instrumented lumbar fusion (fusion levels≥ 4) in the past 5 years with follow-up for at least 2 years. The inclusion criteria included adult patients (≥40 years of age) with a diagnosis of spinal degeneration who underwent instrumented corrective surgery. The exclusion criteria included preexisting adjacent disc degeneration, combined anterior reconstructive surgery, and distal ASD. Clinical and operative characters were evaluated. Angle of lumbar lordosis (LLA), sacral slope (SSA), pelvic tilt (PTA) and pelvic incidence (PIA) were compared preoperatively, postoperatively and at the final follow-up. Results From 2009 to 2014, 60 patients (30 ASD and 30 non-ASD) were enrolled. The average age was 66.82 ± 7.48 years for the study group and 67.97 ± 7.81 years for the control group. There was no statistically significant difference in clinical and operative characteristics. Among all spinopelvic parameters, only pre-, post-operative and final follow-up PIA in ASD group (53.9±10.4ﾟ, 54.6±14.0ﾟ, 54.3±14.1ﾟ) and non-ASD group (60.3±13.0ﾟ, 61.8±11.3ﾟ, 62.5±11.2ﾟ) showed statistically significant differences ( p <0.05). Conclusion This study confirms that preoperative, postoperative and final follow-up PIA is a significant factor contributing to the development of ASD after long instrumented spinal fusion.

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Radiological adjacent-segment degeneration in L4–5 spondylolisthesis: comparison between dynamic stabilization and minimally invasive transforaminal lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2018.1.spine17993 ◽

2018 ◽

Vol 29 (3) ◽

pp. 250-258 ◽

Cited By ~ 7

Author(s):

Chao-Hung Kuo ◽

Wen-Cheng Huang ◽

Jau-Ching Wu ◽

Tsung-Hsi Tu ◽

Li-Yu Fay ◽

...

Keyword(s):

Clinical Outcomes ◽

Disc Degeneration ◽

Interbody Fusion ◽

Degenerative Spondylolisthesis ◽

Transforaminal Lumbar Interbody Fusion ◽

Adjacent Segment Degeneration ◽

Dynamic Stabilization ◽

Adjacent Segment ◽

Secondary Surgery

OBJECTIVEPedicle screw–based dynamic stabilization has been an alternative to conventional lumbar fusion for the surgical management of low-grade spondylolisthesis. However, the true effect of dynamic stabilization on adjacent-segment degeneration (ASD) remains undetermined. Authors of this study aimed to investigate the incidence of ASD and to compare the clinical outcomes of dynamic stabilization and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).METHODSThe records of consecutive patients with Meyerding grade I degenerative spondylolisthesis who had undergone surgical management at L4–5 in the period from 2007 to 2014 were retrospectively reviewed. Patients were divided into two groups according to the surgery performed: Dynesys dynamic stabilization (DDS) group and MI-TLIF group. Pre- and postoperative radiological evaluations, including radiography, CT, and MRI studies, were compared. Adjacent discs were evaluated using 4 radiological parameters: instability (antero- or retrolisthesis), disc degeneration (Pfirrmann classification), endplate degeneration (Modic classification), and range of motion (ROM). Clinical outcomes, measured with the visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and the Japanese Orthopaedic Association (JOA) scores, were also compared.RESULTSA total of 79 patients with L4–5 degenerative spondylolisthesis were included in the analysis. During a mean follow-up of 35.2 months (range 24–89 months), there were 56 patients in the DDS group and 23 in the MI-TLIF group. Prior to surgery, both groups were very similar in demographic, radiological, and clinical data. Postoperation, both groups had similarly significant improvement in clinical outcomes (VAS, ODI, and JOA scores) at each time point of evaluation. There was a lower chance of disc degeneration (Pfirrmann classification) of the adjacent discs in the DDS group than in the MI-TLIF group (17% vs 37%, p = 0.01). However, the DDS and MI-TLIF groups had similar rates of instability (15.2% vs 17.4%, respectively, p = 0.92) and endplate degeneration (1.8% vs 6.5%, p = 0.30) at the cranial (L3–4) and caudal (L5–S1) adjacent levels after surgery. The mean ROM in the cranial and caudal levels was also similar in the two groups. None of the patients required secondary surgery for any ASD (defined by radiological criteria).CONCLUSIONSThe clinical improvements after DDS were similar to those following MI-TLIF for L4–5 Meyerding grade I degenerative spondylolisthesis at 3 years postoperation. According to radiological evaluations, there was a lower chance of disc degeneration in the adjacent levels of the patients who had undergone DDS. However, other radiological signs of ASD, including instability, endplate degeneration, and ROM, were similar between the two groups. Although none of the patients in the present series required secondary surgery, a longer follow-up and a larger number of patients would be necessary to corroborate the protective effect of DDS against ASD.

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EFFECTS ON ADJACENT SEGMENT AFTER MINIMUM FIVE-YEARS FOLLOWING INSTRUMENTED LUMBAR SPINAL FUSION IN INDIAN POPULATION

10.36106/gjra/6811205 ◽

2020 ◽

pp. 132-135

Author(s):

Yogesh Kishorkant Pithwa

Keyword(s):

Spinal Fusion ◽

Lumbar Lordosis ◽

Indian Population ◽

Lower Limbs ◽

Walking Distance ◽

Adjacent Segment ◽

Lumbar Spinal Fusion ◽

Time Of Surgery ◽

Lumbar Spinal

Adjacent segment degeneration [ASD] after instrumented lumbar spinal fusion has been studied extensively in non-Indian population. Present study attempts to evaluate incidence of and factors predisposing to ASD in the Indian population. This was a retrospective study with the inclusion criteria being: patients who underwent lumbar spinal fusion for spondylolisthesis, trauma, infection or deformity with a minimum five-year follow-up. Exclusion criteria: postoperative iatrogenic surgical-site infections, revision surgeries, postoperative implant failure and pseudarthrosis. Radiographs reviewed immediate postoperatively, and at final follow-up. Global lumbar lordosis from L1-S1; and angulation and translation of spinal motion segment immediately adjacent [cranial and caudal] to fused segment were studied. ASD was defined using White and Panjabi’s criteria. At final follow-up, VAS for lower back as well as lower limbs was noted separately along with walking distance. Twenty patients [49.4+17.4years] included [six males, fourteen females]. ASD was seen in 13 of 20 [65%] patients. Age>50years at the time of surgery and global lumbar lordosis <40° in the immediate postoperative period were identified as significant risk factors for ASD [p=0.02 and 0.03, respectively]. However, no significant correlation was noted between development of ASD and extension of fusion to sacrum. Nor was there any correlation between ASD and gender or length of fusion. It was also notable that no significant differences were identified in VAS scores and walking distance between patients with and without ASD. To conclude, among the various factors studied, age>50years at the time of surgery and immediate postoperative global lumbar lordosis <400 were significantly associated with development of ASD after a minimum follow-up of five years.

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190. Ten-year MRI Follow-up After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Accelerated Disc Degeneration in Uninstrumented Levels

The Spine Journal ◽

10.1016/j.spinee.2008.06.228 ◽

2008 ◽

Vol 8 (5) ◽

pp. 95S-96S

Author(s):

Thomas Lawhorne ◽

Daniel Green ◽

Douglas Mintz ◽

Bernard A. Rawlins ◽

Stephen W. Burke ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Disc Degeneration ◽

Posterior Spinal Fusion

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Treatment of adjacent segment disease with percutaneous transforaminal endoscopic discectomy: Early experience and results

Journal of Orthopaedic Surgery ◽

10.1177/2309499020960560 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902096056

Author(s):

Stylianos Kapetanakis ◽

Nikolaos Gkantsinikoudis ◽

Grigorios Gkasdaris ◽

Georgios Charitoudis

Keyword(s):

Spinal Fusion ◽

Short Form ◽

Bodily Pain ◽

Adjacent Segment Disease ◽

Adjacent Segment ◽

Significant Differentiation ◽

Sf 36 ◽

Endoscopic Discectomy ◽

Percutaneous Transforaminal Endoscopic Discectomy

Purpose: Adjacent segment disease (ASD) constitutes a long-term complication of instrumented spinal fusion. Aim of this study is to analyze the utilization of percutaneous transforaminal endoscopic discectomy (PTED) for the treatment of symptomatic ASD, emphasizing basically in the postoperative course. Methods: A prospective study with 35 patients was designed. Patients enrolled in our study were distributed in two different groups. Group A constituted of 15 patients featuring ASD as a complication of a previously conducted lumbar spinal fusion. Group B was composed of 20 patients, presenting simple lumbar disc herniation (LDH). All patients were subjected to successful PTED for LDH. Patients were evaluated at regular intervals in 6-week and 3-, 6-, and 12-month postoperatively. Visual analog scale was utilized for leg (VAS-LP) and low back pain (VAS-BP) evaluation. Health-related quality of life was assessed with short-form 36 health survey questionnaire (SF-36). Results: VAS-BP scores were statistically significantly differentiated between the two groups in all intervals of follow-up. In contrast, VAS-LP scores demonstrated statistically significant differentiation in none of follow-up intervals, indicating similar results between the two groups. Maximal improvement was in both cases for all patients observed in 6-week postoperatively, with subsequent stabilization. SF-36 preoperative evaluation denoted a statistically significant differentiation in bodily pain and role emotional parameters, which was continually until the end of follow-up observed. The other SF-36 parameters featured similar values between the two groups preoperatively as well as during the follow-up intervals. Conclusion: PTED is capable of successfully dealing with LDH and furthermore with complications of fusion as ASD.

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Spinal Alignments of Residual Lumbar Curve Affect Disc Degeneration after Spinal Fusion in Patients with Adolescent Idiopathic Scoliosis: Follow-up after 5 or More Years

Spine Surgery and Related Research ◽

10.22603/ssrr.2019-0048 ◽

2020 ◽

Vol 4 (1) ◽

pp. 50-56

Author(s):

Tsutomu Akazawa ◽

Tasuku Umehara ◽

Masahiro Iinuma ◽

Kota Asano ◽

Shingo Kuroya ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Disc Degeneration ◽

Lumbar Curve

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Predicting factors of adjacent segment degeneration after long-segment spinal fusion: spinopelvic parameters analysis

10.21203/rs.2.18590/v1 ◽

2019 ◽

Author(s):

Ping-Yeh Chiu ◽

Fu-Cheng Kao ◽

Wen-Jer Chen ◽

Chia-Wei Yu ◽

Chi-Chien Niu ◽

...

Keyword(s):

Spinal Fusion ◽

Lumbar Fusion ◽

Slope Angle ◽

Adjacent Segment Degeneration ◽

Control Group ◽

Adjacent Segment ◽

Spinopelvic Parameters ◽

Significant Difference ◽

Adjacent Disc

Abstract Purpose We investigated whether spinopelvic parameters are important prognostic factors for adjacent segment degeneration after long instrumented spinal fusion for degenerative spinal disease. Methods This uncontrolled, randomized, single arm retrospective study included patients who underwent long instrumented lumbar fusion (fusion levels≥ 4) in the past 5 years with follow-up for at least 2 years. The inclusion criteria included adult patients (≥40 years of age) with a diagnosis of spinal degeneration who underwent instrumented corrective surgery. The exclusion criteria included preexisting adjacent disc degeneration, combined anterior reconstructive surgery, and distal ASD. Clinical and operative characters were evaluated. Lumbar lordotic angle (LLA), sacral slope angle (SSA), pelvic tilt angle (PTA) and pelvic incidence angle (PIA) were compared preoperatively, postoperatively and at the final follow-up. Results From 2009 to 2014, 60 patients (30 ASD and 30 non-ASD patients) were enrolled. The average age was 66.82 ± 7.48 years for the study group and 67.97 ± 7.81 years for the control group. There was no statistically significant difference in clinical and operative characteristics. Among all spinopelvic parameters, only pre-, post-operative and final follow-up PIA in ASD group (53.9±10.4ﾟ, 54.6±14.0ﾟ, 54.3±14.1ﾟ) and non-ASD group (60.3±13.0ﾟ, 61.8±11.3ﾟ, 62.5±11.2ﾟ) showed statistically significant differences (p<0.05). Conclusion This study confirms that preoperative, postoperative and final follow-up PIA is a significant factor contributing to the development of adjacent segment degeneration after long instrumented spinal fusion.

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