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

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.

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

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

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.

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

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

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.

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

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.

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

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.

scholarly journals Evaluation of Adjacent Segment With Pre-Existing Degeneration Using the Cerebrospinal Fluid Occlusion Sign on MRI Before Posterior Lumbar Fusion: A Multi-Center Observational Cohort Study

2021 ◽  
pp. 219256822110071
Author(s):  
Zhuoran Sun ◽  
Zhuofu Li ◽  
Yang Guo ◽  
Weishi Li ◽  
Xin Chen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cohort Study ◽  
Lumbar Fusion ◽  
Disease Incidence ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Frequent Type ◽  
Canal Stenosis ◽  
Significant Difference

Study Design: Prospective cohort study. Objective: To evaluate whether pre-existing adjacent spinal canal stenosis (SCS) is associated with short-term outcomes after lumbar fusion surgery. Methods: We included patients with lumbar spinal stenosis treated surgically between July 2015 and December 2017 at 4 centers. All patients had the same pathology, with L4-S1 as the culprit sections. Patients were divided into 2 groups based on the cerebrospinal fluid occlusion sign on MRI at the adjacent L3/4 level. Patients without SCS (grade 0) and with mild SCS (grade 1) were classified into the non-stenosis (NS) and mild stenosis (MS) groups, respectively. All patients underwent PLIF and completed at least 1-year follow-up. The incidence of adjacent segment degeneration (ASDeg) and clinical outcomes were compared between the 2 groups. Results: A total of 308 patients (NS, 156; MS, 152) met the inclusion criteria. The incidence of ASDeg in the NS group (n = 40, 25.6%) was significantly lower than that in the MS group (n = 74, 48.7%; P < .001). The most frequent type of ASDeg in the 2 groups was the SCS-aggravated type. No significant difference was observed in adjacent segment disease incidence between the 2 groups ( P = .243). The NS group had better outcomes according to the clinical function scores ( P < .05). Conclusions: The cerebrospinal fluid occlusion sign on MRI is valuable for evaluating the adjacent segment with pre-existing degeneration. Patients with mild SCS in adjacent segments were more likely to have ASDeg, and the most frequent type of ASDeg was the SCS-aggravated type at early follow-up.

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.

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.

Adjacent-segment effects of lumbar cortical screw–rod fixation versus pedicle screw–rod fixation with and without interbody support

2021 ◽  
pp. 1-7
Author(s):  
Piyanat Wangsawatwong ◽  
Anna G. U. Sawa ◽  
Bernardo de Andrada Pereira ◽  
Jennifer N. Lehrman ◽  
Luke K. O’Neill ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Statistical Significance ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Lateral Bending ◽  
Single Level ◽  
Cortical Screw ◽  
Flexion Extension

OBJECTIVE Cortical screw–rod (CSR) fixation has emerged as an alternative to the traditional pedicle screw–rod (PSR) fixation for posterior lumbar fixation. Previous studies have concluded that CSR provides the same stability in cadaveric specimens as PSR and is comparable in clinical outcomes. However, recent clinical studies reported a lower incidence of radiographic and symptomatic adjacent-segment degeneration with CSR. No biomechanical study to date has focused on how the adjacent-segment mobility of these two constructs compares. This study aimed to investigate adjacent-segment mobility of CSR and PSR fixation, with and without interbody support (lateral lumbar interbody fusion [LLIF] or transforaminal lumbar interbody fusion [TLIF]). METHODS A retroactive analysis was done using normalized range of motion (ROM) data at levels adjacent to single-level (L3–4) bilateral screw–rod fixation using pedicle or cortical screws, with and without LLIF or TLIF. Intact and instrumented specimens (n = 28, all L2–5) were tested using pure moment loads (7.5 Nm) in flexion, extension, lateral bending, and axial rotation. Adjacent-segment ROM data were normalized to intact ROM data. Statistical comparisons of adjacent-segment normalized ROM between two of the groups (PSR followed by PSR+TLIF [n = 7] and CSR followed by CSR+TLIF [n = 7]) were performed using 2-way ANOVA with replication. Statistical comparisons among four of the groups (PSR+TLIF [n = 7], PSR+LLIF [n = 7], CSR+TLIF [n = 7], and CSR+LLIF [n = 7]) were made using 2-way ANOVA without replication. Statistical significance was set at p < 0.05. RESULTS Proximal adjacent-segment normalized ROM was significantly larger with PSR than CSR during flexion-extension regardless of TLIF (p = 0.02), or with either TLIF or LLIF (p = 0.04). During lateral bending with TLIF, the distal adjacent-segment normalized ROM was significantly larger with PSR than CSR (p < 0.001). Moreover, regardless of the types of screw-rod fixations (CSR or PSR), TLIF had a significantly larger normalized ROM than LLIF in all directions at both proximal and distal adjacent segments (p ≤ 0.04). CONCLUSIONS The use of PSR versus CSR during single-level lumbar fusion can significantly affect mobility at the adjacent segment, regardless of the presence of TLIF or with either TLIF or LLIF. Moreover, the type of interbody support also had a significant effect on adjacent-segment mobility.

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