scholarly journals A descriptive study on the adjacent segment degeneration related signs following a lumbar fusion procedure

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
José Ramírez-Villaescusa ◽  
Jesús López-Torres Hidalgo ◽  
David Ruiz-Picazo ◽  
Antonio Martín-Benlloch
Keyword(s):  
Lumbar Fusion ◽  
Descriptive Study ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Fusion Procedure

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.

Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion

2016 ◽  
Vol 16 (7) ◽  
pp. 867-875 ◽  
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

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

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.

scholarly journals Early Adjacent Segment Degeneration after Short Lumbar Fusion

2016 ◽  
Vol 6 (1_suppl) ◽  
pp. s-0036-1582968-s-0036-1582968
Author(s):  
Sergei Masevnin ◽  
Dmitry Ptashnikov ◽  
Dmitry Mikhaylov ◽  
Oleg Smekalenkov ◽  
Nikita Zaborovskii ◽  
...  
Keyword(s):  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment

Protective effects of preserving the posterior complex on the development of adjacent-segment degeneration after lumbar fusion

2013 ◽  
Vol 19 (2) ◽  
pp. 201-206 ◽  
Author(s):  
Haichun Liu ◽  
Wenliang Wu ◽  
Yi Li ◽  
Jinwei Liu ◽  
Kaiyun Yang ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Facet Joint ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
The Other ◽  
Disc Height ◽  
Adjacent Segment ◽  
Number Of Patients ◽  
Group A

Object During the past decades, lumbar fusion has increasingly become a standard treatment for degenerative spinal disorders. However, it has also been associated with an increased incidence of adjacent-segment degeneration (ASD). Previous studies have reported less ASD in anterior fusion surgeries; thus, the authors hypothesized that the integrity of the posterior complex plays an important role in ASD. This study was designed to investigate the effect of the posterior complex on adjacent instability after lumbar instrumentation and the development of ASD. Methods To evaluate different surgical interventions, 120 patients were randomly allocated into 3 groups of 40 patients each who were statistically similar with respect to demographic and clinical data. Patients in Group A were allocated for facet joint resection and L4–5 fusion, Group B for semilaminectomy and fusion, and Group C for complete laminectomy and fusion. All of the patients were followed up for 5–7 years (mean 5.9 years). The disc height, intervertebral disc angle, dynamic intervertebral angular range of motion (ROM), L3–4 slip, and the total lordosis angle were each measured before the operation and at the final follow-up. The Japanese Orthopaedic Association (JOA) score was determined before surgery and at the final follow-up to evaluate the clinical results. Results Among the 3 groups, no significant differences were detected in all clinical and demographic assessments before surgery. At 3 months after surgery, the JOA score of all groups improved significantly and showed no significant differences among the groups. At the final follow-up, Group C had a significantly (p < 0.05) lower JOA score than the other 2 groups. Moreover, the disc height and total lumbar lordosis in patients of Group C were significantly decreased compared with disc height and total lumbar lordosis in the other 2 groups. In contrast, disc angle, dynamic angular ROM, and listhesis were significantly higher in Group C than in the other 2 groups. Twenty-four patients showed signs of ASD after the operation (3 patients in Group A, 4 in B, and 17 in C). The number of patients in Group C showing ASD was significantly different from that in Groups A and B. Conclusions During follow-up for 6 years, a significantly higher number of patients with ASD were noted in the complete-laminectomy group. The number of reoperations for treating ASD was much higher in this patient group than in the patients undergoing facet joint resection and L4–5 fusion or semilaminectomy and fusion. Therefore, preserving the posterior complex as much as possible during surgery plays an important role in preventing ASD and in reducing the reoperation rate.

scholarly journals Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders: a meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Tao Wang ◽  
Wenyuan Ding
Keyword(s):  
Risk Factors ◽  
Lumbar Fusion ◽  
Meta Analysis ◽  
Adjacent Segment Degeneration ◽  
Cochrane Library ◽  
Adjacent Segment ◽  
Fusion Surgery ◽  
Posterior Lumbar Fusion ◽  
Lumbar Fusion Surgery ◽  
History Of

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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