The impact of spinopelvic parameters on the rate of adjacent segment instability after short-segment spinal fusion

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.

Download Full-text

The impact of obesity measured by outer abdominal fat on instability of the adjacent segments after rigid pedicle screw fixation

Orthopedic Reviews ◽

10.4081/or.2018.7684 ◽

2018 ◽

Vol 10 (2) ◽

Cited By ~ 1

Author(s):

Maximilian Lenz ◽

Carolin Meyer ◽

Christoph Kolja Boese ◽

Jan Siewe ◽

Peer Eysel ◽

...

Keyword(s):

Spinal Fusion ◽

Spinal Surgery ◽

Abdominal Fat ◽

Pedicle Screw Fixation ◽

Adjacent Segment ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Lack Of Information ◽

Adjacent Segments ◽

The Impact

Previous studies have shown coherence between obesity and higher rates of complications following spinal surgery. However, there is a lack of information about the influence of obesity and the mass of outer abdominal fat (OAF) on adjacent segment instability after spinal fusion surgery. Radiographs of 194 patients with spinal fusion surgery were assessed retrospectively. Radiographs were performed after surgery during two years’ follow-up and signs of adjacent segment instability were documented. Patients were classified regarding their BMI and extent of OAF was assessed using CT at the umbilical level. In 20 patients (10.3%) instability of adjacent segments occurred during followup. In this cohort mean OAF was significantly thicker (28.07 mm) compared to the patients without instability (22.39) (P=0.038). A total of 45% of patients with instability showed OAF of more than 30 mm at time of intervention compared to 10% in those without signs of instability. There exists significant correlation between the extent of OAF and development of adjacent segment instability postoperatively. Thus, weight reduction before spinal surgery could potentially decrease risk of adjacent segment instability.

Download Full-text

The influence of spinopelvic parameters on adjacent-segment degeneration after short spinal fusion for degenerative spondylolisthesis

Journal of Neurosurgery Spine ◽

10.3171/2018.2.spine171160 ◽

2018 ◽

Vol 29 (4) ◽

pp. 407-413 ◽

Cited By ~ 4

Author(s):

Ming-Kai Hsieh ◽

Fu-Cheng Kao ◽

Wen-Jer Chen ◽

I-Jung Chen ◽

Sheng-Fen Wang

Keyword(s):

Spinal Fusion ◽

Degenerative Spondylolisthesis ◽

Slope Angle ◽

Adjacent Segment Degeneration ◽

Control Group ◽

Adjacent Segment ◽

Spinopelvic Parameters ◽

Lumbosacral Fusion ◽

Single Level ◽

Matching Criteria

OBJECTIVESpinopelvic parameters, such as the pelvic incidence (PI) angle, sacral slope angle, and pelvic tilt angle, are important anatomical indices for determining the sagittal curvature of the spine and the individual variability of the lumbar lordosis (LL) curve. The aim of this study was to investigate the influence of spinopelvic parameters and LL on adjacent-segment degeneration (ASD) after short lumbar and lumbosacral fusion for single-level degenerative spondylolisthesis.METHODSThe authors retrospectively reviewed the records of all short lumbar and lumbosacral fusion surgeries performed between August 2003 and July 2010 for single-level degenerative spondylolisthesis in their orthopedic department.RESULTSA total of 30 patients (21 women and 9 men, mean age 64 years) with ASD after lower lumbar or lumbosacral fusion surgery comprised the study group. Thirty matched patients (21 women and 9 men, mean age 63 years) without ASD comprised the control group, according to the following matching criteria: same diagnosis on admission, similar pathologic level (≤ 1 level difference), similar sex, and age. The average follow-up was 6.8 years (range 5–8 years). The spinopelvic parameters had no significant influence on ASD after short spinal fusion.CONCLUSIONSNeither the spinopelvic parameters nor a mismatch of PI and LL were significant factors responsible for ASD after short spinal fusion due to single-level degenerative spondylolisthesis.

Download Full-text

Adjacent Segment Degeneration After Lumbar Spinal Fusion: The Impact of Anterior Column Support

Spine ◽

10.1097/brs.0b013e3181e57269 ◽

2010 ◽

Vol 35 (22) ◽

pp. 1955-1964 ◽

Cited By ~ 30

Author(s):

Tina S. Videbaek ◽

Niels Egund ◽

Finn B. Christensen ◽

Anne Grethe Jurik ◽

Cody E. Bünger

Keyword(s):

Spinal Fusion ◽

Adjacent Segment Degeneration ◽

Anterior Column ◽

Adjacent Segment ◽

Lumbar Spinal Fusion ◽

Anterior Column Support ◽

Lumbar Spinal ◽

The Impact

Download Full-text

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.

Download Full-text

The Impact of Adjacent Segment Degeneration on the Clinical Outcome After Lumbar Spinal Fusion

Spine ◽

10.1097/brs.0b013e3181657dc3 ◽

2008 ◽

Vol 33 (5) ◽

pp. 503-507 ◽

Cited By ~ 48

Author(s):

Jun Young Yang ◽

June-Kyu Lee ◽

Ho-Sup Song

Keyword(s):

Clinical Outcome ◽

Spinal Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Lumbar Spinal Fusion ◽

Lumbar Spinal ◽

The Impact

Download Full-text

Management of Deep Spinal Wound Infections Following Instrumentation Surgery with Subfascial Negative Pressure Wound Therapy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1720999 ◽

2021 ◽

Author(s):

Marcus Rickert ◽

Michael Rauschmann ◽

Nizar Latif-Richter ◽

Mohammad Arabmotlagh ◽

Tamin Rahim ◽

...

Keyword(s):

Risk Factors ◽

Wound Healing ◽

Wound Infection ◽

Spinal Fusion ◽

Negative Pressure Wound Therapy ◽

Wound Infections ◽

Wound Therapy ◽

Postoperative Wound ◽

Deep Wound ◽

The Impact

Abstract Background and Study Aims The treatment of infections following a spine surgery continues to be a challenge. Negative pressure wound therapy (NPWT) has been an effective method in the context of infection therapy, and its use has gained popularity in recent decades. This study aims to analyze the impact of known risk factors for postoperative wound infection on the efficiency and length of NPWT therapy until healing. Patients and Methods We analyzed 50 cases of NPWT treatment for deep wound infection after posterior and posteroanterior spinal fusion from March 2010 to July 2014 retrospectively. We included 32 women and 18 men with a mean age of 69 years (range, 36–87 years). Individual risk factors for postoperative infection, such as age, gender, obesity, diabetes, immunosuppression, duration of surgery, intraoperative blood loss, and previous surgeries, as well as type and onset (early vs. late) of the infection were analyzed. We assessed the associations between these risk factors and the number of revisions until wound healing. Results In 42 patients (84%), bacterial pathogens were successfully detected by means of intraoperative swabs and tissue samples during first revision. A total of 19 different pathogens could be identified with a preponderance of Staphylococcus epidermidis (21.4%) and S. aureus (19.0%). Methicillin-resistant S. aureus (MRSA) was recorded in two patients (2.6%). An average of four NPWT revisions was required until the infection was cured. Patients with infections caused by mixed pathogens required a significantly higher number of revisions (5.3 vs. 3.3; p < 0.01) until definitive wound healing. For the risk factors, no significant differences in the number of revisions could be demonstrated when compared with the patients without the respective risk factor. Conclusion NPWT was an effective therapy for the treatment of wound infections after spinal fusion. All patients in the study had their infections successfully cured, and all spinal implants could be retained. The number of revisions was similar to those reported in the published literature. The present study provides insights regarding the effectiveness of NPWT for the treatment of deep wound infection after spinal fusion. Further investigations on the impact of potential risk factors for postoperative wound healing disorders are required. Better knowledge on the impact of specific risk factors will contribute to a higher effectiveness of prophylaxis for postoperative wound infections considering the patient-specific situation.

Download Full-text

Cervical sagittal alignment after Prestige LP cervical disc replacement: radiological results and clinical impacts from a single-center experience

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-03962-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Xiaofei Wang ◽

Yang Meng ◽

Hao Liu ◽

Hua Chen ◽

Beiyu Wang ◽

...

Keyword(s):

Sagittal Alignment ◽

Disc Replacement ◽

Cervical Disc ◽

Adjacent Segment ◽

Single Center ◽

Disc Disease ◽

Sagittal Vertical Axis ◽

Cervical Disc Replacement ◽

Cervical Sagittal Alignment ◽

The Impact

Abstract Background Cervical disc replacement (CDR) has been widely used to treat one- and two-level cervical degenerative disc disease. Studies have shown the effectiveness of CDR in preserving range of motion (ROM) and delaying adjacent segment degeneration (ASD). Cervical sagittal alignment is an important factor affecting favorable clinical outcomes in cervical spine surgery. This study aimed to explore whether cervical sagittal alignment can be maintained after CDR and to identify the impact of cervical sagittal alignment on outcomes after CDR. Methods This was a single-center, retrospective study. 132 patients who underwent one-level CDR were included. Cervical sagittal alignments, including cervical lordosis (CL), segmental alignment (SA), sagittal vertical axis (SVA), T1 slope (T1s), and T1s minus CL (T1s-CL), were measured. The effects of cervical sagittal alignment on the CDR outcomes were analyzed. Patients were divided into the heterotopic ossification (HO) group and ASD group to determine the potential impacts of cervical sagittal parameters. Results The cervical sagittal alignment parameters, except for the SVA, were significantly improved after CDR and showed decreasing trends at the last follow-up. Significantly higher CL and T1s were found in patients with better ROM after CDR. SVA ≥ 20 mm increased the risk of anterior HO (odds ratio = 2.945, P = 0.007). Significantly kyphotic SA and lower T1s values were found in the ASD patients than in the non-ASD patients (P < 0.05). Patients with ASD at the inferior level showed significantly worse CL (P < 0.05). Conclusion CDR had limited function of improving cervical sagittal alignment. Poor cervical sagittal alignment after CDR was associated with HO, ASD, and less ROM.

Download Full-text