Staged surgical strategy of symptomatic lumbar adjacent-segment degeneration: full-endoscopic decompression versus extended posterior interbody fusion

Abstract Background Symptomatic adjacent-segment degeneration (ASD) is a common complication after lumbar fusion surgery. We want to evaluate the clinical and imaging outcome of full-endoscopic lumbar decompression (FELD) in comparison with extended posterior lumbar interbody fusion (PLIF) for ASD after lumbar fusion surgeries and develop a staged revision strategy. Methods This retrospective study enrolled 65 patients with ASD who treated with FELD (n=31) or extended PLIF (n=34) between January 2014 and January 2018. Clinical outcome evaluations were performed preoperatively, at 3, 12, 24 months postoperatively, including Oswestry Disability Index (ODI) score and Japanese Orthopaedic Association (JOA) scores for function assessment, visual analog scale (VAS) scores for low-back pain and leg pain. Imaging outcome evaluations were performed preoperatively, immediately after surgery and at the last follow up, including disc height (DH) and lumbar lordosis (LL). Results The ratio of patients with adjacent segmental instability in the PLIF group was significantly higher than that in the FELD group (p<0.05). There was no significant difference in other baseline data for FELD and PLIF groups (p>0.05). Mean operative time, blood loss and length of hospital stay were significantly decreased for the FELD group (p<0.001). For patients with stable adjacent segments, there was no significant difference in preoperative and postoperative low-back pain, leg pain and function between 2 groups (p>0.05). The patients in PLIF group had restored DH after surgery, which was significantly higher than FELD group (p<0.05). For patients with unstable adjacent segments, the low-back and leg pain of PLIF group were significantly relieved than that in FELD group within 24 and 3 months after surgery (p<0.05). The function of PLIF group was significantly improved within 12 months after surgery (p<0.05). The DH was only significantly restored within 3 months after surgery (p<0.05). Recurrence was found in 2 (6.5%, p>0.05) patients in FELD group, while no patient in PLIF group had recurrence. Conclusions FELD could achieve satisfactory safety and efficacy for the treatment of stable ASD, which was not worse than PLIF. With less trauma and faster recovery, FELD may be an alternative surgical treatment for stable ASD.

Download Full-text

Staged surgical strategy of symptomatic lumbar adjacent-segment degeneration: full-endoscopic decompression versus extended posterior interbody fusion

10.21203/rs.2.21687/v1 ◽

2020 ◽

Author(s):

Tong Li ◽

Bin Zhu ◽

Xiaoguang Liu

Keyword(s):

Low Back Pain ◽

Interbody Fusion ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Leg Pain ◽

Adjacent Segment ◽

Low Back ◽

Significant Difference ◽

Adjacent Segments ◽

Outcome Evaluations

Download Full-text

Can relative rotation angle serve as a sensitive predictor for the development of adjacent segment degeneration after single-segment PLIF?

10.21203/rs.3.rs-18055/v1 ◽

2020 ◽

Author(s):

Xiao Liu ◽

Haonan Liu ◽

Xiaosong Yang ◽

Zhongjun Liu ◽

xiaoguang liu ◽

...

Keyword(s):

Rotation Angle ◽

Lumbar Fusion ◽

Measurement Data ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Relative Rotation ◽

Significant Difference ◽

Flexion Extension ◽

Adjacent Segments ◽

Adjacent Vertebra

Abstract Background: Adjacent segment degeneration (ASD) is a major issue after posterior lumbar interbody fusion (PLIF). Several studies have reported the potential causes of ASD based on radiography. However, the postoperative dynamic changes in the adjacent segments are not clear. This study aimed to determine the effect of PLIF on ASD using a formetric 4D system and to compare the effectiveness of this system with that of traditional radiography for the prediction of ASD. Methods: Eighty-five consecutive patients who underwent PLIF of a single-segmen t were included. The formetric 4Dsystem was used to calculate the relative rotation angle between the fusion segment and the upper and lower adjacent vertebrae preoperatively and at 6, 12 and 24 months postoperatively. The range of motion (ROM) and disc height (DH) of the adjacent segments were measured using radiography preoperatively and at 24 months postoperatively. At the final follow-up, the visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the surgical outcome. The patients were divided into two groups according to the occurrence of radiographic ASD: the ASD group with progression of degeneration and the N-ASD group without progression of degeneration. The clinical outcomes and measurement data between the two groups were compared and analyzed. Results: The index fusion segments included L2-3 to L5-S1. Preoperatively, the relative rotation angles between the fused segment and the upper and lower adjacent vertebrae were 5.1°±2.2°and 3.3°±2.0°,respectively, and both angles increased significantly at all time-points after surgery ( p <0.05). The angles changed most significantly during L2-3 fusion . Radiographic ASD was noted in 13 of 85 patients (15.3%) at 24 months. There was no significant difference in the DH, ROM, or clinical outcome between the two groups ( p >0.05), while the relative rotation angle with the upper adjacent vertebra was greater in the ASD group than in the N-ASD group ( p <0.05). Conclusion: The relative rotation angle with the adjacent vertebra increased significantly after lumbar fusion surgery. It may be a more sensitive predictor for the development ofradiographic ASD than flexion-extension ROM and DH.

Download Full-text

Microendoscopic Decompression for Lumbar Spinal Stenosis Associated with Adjacent Segment Disease following Lumbar Fusion Surgery: 5-year Follow-up of a Retrospective Case Series

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1739206 ◽

2021 ◽

Author(s):

Shizumasa Murata ◽

Akihito Minamide ◽

Yukihiro Nakagawa ◽

Hiroshi Iwasaki ◽

Hiroshi Taneichi ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Japanese Orthopaedic Association ◽

Leg Pain ◽

Adjacent Segment ◽

Low Back ◽

Spinal Decompression ◽

Analog Scale ◽

Clinically Important Difference ◽

Lumbar Spinal

Abstract Background and Study Aims Surgical treatment options for lumbar spinal stenosis (LSS) based on adjacent segment disease (ASD) after spinal fusion typically involve decompression, with or without fusion, of the adjacent segment. The clinical benefits of microendoscopic decompression for LSS based on ASD have not yet been fully elucidated. We aimed to investigate the clinical results of microendoscopic spinal decompression surgery for LSS based on ASD. Patients and Methods From 2011 to 2014, consecutive patients who underwent microendoscopic spinal decompression without fusion for LSS based on ASD were enrolled. Data of 32 patients (17 men and 15 women, with a mean age of 70.5 years) were reviewed. Japanese Orthopaedic Association score and low back pain/leg pain visual analog scale score were utilized to measure neurologic and axial pain outcomes, respectively. Additionally, after the surgeries, we analyzed the magnetic resonance imaging (MRI), computed tomography (CT) scans, or radiographs to identify any new instabilities of the decompressed segments or progression of ASD adjacent to the decompressed segments. Results The Japanese Orthopaedic Association recovery rate at the 5-year postoperative visit was 49.2%. The visual analog scale scores for low back pain and leg pain were significantly improved. The minimum clinically important difference for leg pain (decrease by ≥24 mm) and clinically important difference for low back pain (decrease by ≥38 mm) were achieved in 84% (27/32) and 72% (23/32) of cases, respectively. Regarding new instability after microendoscopic decompression, no cases had apparent spinal instability at the decompression segment and adjacent segment to the decompressed segment. Conclusions Microendoscopic spinal decompression is an effective treatment alternative for patients with LSS caused by ASD. The ability to perform neural decompression while maintaining key stabilizing structures minimizes subsequent clinical instability. The substantial clinical and economic benefits of this approach may make it a favorable alternative to performing concurrent fusion in many patients.

Download Full-text

Does Atherosclerosis Have Negative Impacts on Early Adjacent Segment Degeneration After Posterior Lumbar Interbody Fusion?

Global Spine Journal ◽

10.1177/2192568220919370 ◽

2020 ◽

pp. 219256822091937

Author(s):

Hironobu Sakaura ◽

Daisuke Ikegami ◽

Takahito Fujimori ◽

Tsuyoshi Sugiura ◽

Yoshihiro Mukai ◽

...

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Surrogate Marker ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Significant Difference ◽

Degenerative Lumbar Spondylolisthesis ◽

Negative Impacts

Study Design: Retrospective study. Objective: To examine whether atherosclerosis has negative impacts on early adjacent segment degeneration (ASD) after posterior lumbar interbody fusion using traditional trajectory pedicle screw fixation (TT-PLIF). Methods: The subjects were 77 patients who underwent single-level TT-PLIF for degenerative lumbar spondylolisthesis. Using dynamic lateral radiographs of the lumbar spine before surgery and at 3 years postoperatively, early radiological ASD (R-ASD) was examined. Early symptomatic ASD (S-ASD) was diagnosed when neurologic symptoms deteriorated during postoperative 3-year follow-up and the responsible lesions adjacent to the fused segment were also confirmed on magnetic resonance imaging. According to the scoring system by Kauppila et al, the abdominal aortic calcification score (AAC score: a surrogate marker of systemic atherosclerosis) was assessed using preoperative lateral radiographs of the lumbar spine. Results: The incidence of early R-ASD was 41.6% at the suprajacent segment and 8.3% at the subjacent segment, respectively. Patients with R-ASD had significantly higher AAC score than those without R-ASD. The incidence of early S-ASD was 3.9% at the suprajacent segment and 1.4% at the subjacent segment, respectively. Patients with S-ASD had higher AAC score than those without S-ASD, although there was no significant difference. Conclusions: At 3 years after surgery, the advanced AAC had significantly negative impacts on early R-ASD after TT-PLIF. This result indicates that impaired blood flow due to atherosclerosis can aggravate degenerative changes at the adjacent segments of the lumbar spine after PLIF.

Download Full-text

Vertebral osteolytic defect due to cellulose particles derived from gauze fibers after posterior lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2014.8.spine14196 ◽

2014 ◽

Vol 21 (6) ◽

pp. 877-881 ◽

Cited By ~ 1

Author(s):

Shota Takenaka ◽

Yoshihiro Mukai ◽

Noboru Hosono ◽

Kosuke Tateishi ◽

Takeshi Fuji

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Interbody Fusion ◽

Histopathological Examination ◽

Lumbar Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Low Back ◽

Lumbar Interbody Fusion ◽

Body Type ◽

Initial Surgery

Vertebral cystic lesions may be observed in pseudarthroses after lumbar fusion surgery. The authors report a rare case of pseudarthrosis after spinal fusion, accompanied by an expanding vertebral osteolytic defect induced by cellulose particles. A male patient originally presented at the age of 69 years with leg and low-back pain caused by a lumbar isthmic spondylolisthesis. He underwent a posterior lumbar interbody fusion, and his neurological symptoms and pain resolved within a year but recurred 14 months after surgery. Radiological imaging demonstrated a cystic lesion on the inferior endplate of L-5 and the superior endplate of S-1, which rapidly enlarged into a vertebral osteolytic defect. The patient underwent revision surgery, and his low-back pain resolved. A histopathological examination demonstrated foreign body–type multinucleated giant cells, containing 10-μm particles, in the sample collected just below the defect. Micro–Fourier transform infrared spectroscopy revealed that the foreign particles were cellulosic, presumably originating from cotton gauze fibers that had contaminated the interbody cages used during the initial surgery. Vertebral osteolytic defects that occur after interbody fusion are generally presumed to be the result of infection. This case suggests that some instances of vertebral osteolytic defects may be aseptically induced by foreign particles. Hence, this possibility should be carefully considered in such cases, to help prevent contamination of the morselized bone used for autologous grafts by foreign materials, such as gauze fibers.

Download Full-text

A Modified Method to Treat Severe Asymptomatic Pre-existing Degeneration of Adjacent Segment: A Retrospective Case-Control Study

10.21203/rs.3.rs-70798/v1 ◽

2020 ◽

Author(s):

Xinliang Zhang ◽

Jinwen Zhu ◽

Yibing Li ◽

Dingjun Hao ◽

Wenjie Gao

Keyword(s):

Interbody Fusion ◽

Operation Time ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Retrospective Case ◽

Modified Method ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background: Pre-existing degeneration of adjacent segment is an important risk factor for adjacent segment degeneration (ASD), but limited and controversial studies have addressed its management.Methods: Patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment were retrospectively analyzed. Among them, those who underwent interbody fusion in the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion in the adjacent L4/5 segment were included as Group A (n=103). Patients who underwent interbody fusion in both L5/S1 and L4/5 segments were included as Group B (n=81). Clinical and radiographic outcomes were evaluated.Results: Mean follow-up was 58.5 months (range, 48-75 m). No significant difference in clinical outcomes or the incidence of adjacent segment degeneration in L3/4 segment was found between Groups A and B. Compared with Group B, less bleeding (315±84 vs. 532±105 ml), shorter operation time (107±34 vs. 158±55 min) and lower costs (13,830±2640 vs. 16,020±3380 US$) were found in Group A (P<0.05). In Group A, disc height ratio (DHR) of L4/5 segment was significantly increased from preoperative value of 0.40±0.13 to last follow-up value of 0.53±0.18 (P<0.05), while the degree of canal stenosis (DCS) was decreased from preoperative value of 34.3±11.2% to last follow-up value of 15.9±9.3% (P<0.05). Conclusions: This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in lumbar spine.

Download Full-text

Treatment of postdiscectomy low back pain by percutaneous posterior lumbar interbody fusion versus open posterior lumbar fusion with pedicle screws

The Spine Journal ◽

10.1016/j.spinee.2007.07.393 ◽

2008 ◽

Vol 8 (5) ◽

pp. 741-746 ◽

Cited By ~ 8

Author(s):

Reuven Gepstein ◽

Shay Shabat ◽

Michael Reichel ◽

Ilia Pikarsky ◽

Yoram Folman

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Interbody Fusion ◽

Lumbar Fusion ◽

Pedicle Screws ◽

Posterior Lumbar Interbody Fusion ◽

Low Back ◽

Lumbar Interbody Fusion ◽

Posterior Lumbar Fusion

Download Full-text

A modified method to treat severe asymptomatic pre‐existing degeneration of adjacent segment: a retrospective case‐control study

BMC Surgery ◽

10.1186/s12893-021-01163-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xinliang Zhang ◽

Jinwen Zhu ◽

Yibing Li ◽

Dingjun Hao ◽

Wenjie Gao

Keyword(s):

Interbody Fusion ◽

Operation Time ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Retrospective Case ◽

Modified Method ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background Pre-existing degeneration of adjacent segment is an important risk factor for adjacent-segment degeneration (ASD), but only limited and controversial studies have addressed its management. Methods We retrospectively analyzed patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment. Of these patients, those who underwent interbody fusion of the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion of the adjacent L4/5 segment were included in Group A (n = 103), while those who underwent interbody fusion of both the L5/S1 and L4/5 segments were included in Group B (n = 81). Clinical and radiographic outcomes were evaluated. Results Mean follow-up time was 58.5 months (range, 48–75 months). We found no significant difference in clinical outcomes or incidence of ASD in the L3/4 segment between Groups A and B. Compared with Group B, Group A experienced less bleeding (315 ± 84 ml vs. 532 ± 105 ml), shorter operation time (107 ± 34 min vs. 158 ± 55 min) and lower costs (US $13,830 ± $2640 vs. US $16,020 ± $3380; P < 0.05). In Group A, the disc height ratio (DHR) of the L4/5 segment was significantly increased from a preoperative value of 0.40 ± 0.13 to a last–follow-up value of 0.53 ± 0.18 (P < 0.05), while the degree of canal stenosis (DCS) was decreased from a preoperative value of 34.3 ± 11.2% to a last–follow-up value of 15.9 ± 9.3 % (P < 0.05). Conclusions This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in the lumbar spine.

Download Full-text

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.

Download Full-text