scholarly journals Is the Goutallier grade of multifidus fat infiltration associated with adjacent-segment degeneration after lumbar spinal fusion?

2020 ◽  
pp. 1-6
Author(s):  
Ping-Guo Duan ◽  
Praveen V. Mummaneni ◽  
Jeremy M. V. Guinn ◽  
Joshua Rivera ◽  
Sigurd H. Berven ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Demographic Data ◽  
Degenerative Spondylolisthesis ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Fat Infiltration ◽  
Single Level ◽  
Goutallier Classification ◽  
Spinopelvic Parameter

OBJECTIVEThe aim of this study was to investigate whether fat infiltration of the lumbar multifidus (LM) muscle affects revision surgery rates for adjacent-segment degeneration (ASD) after L4–5 transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis.METHODSA total of 178 patients undergoing single-level L4–5 TLIF for spondylolisthesis (2006 to 2016) were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, preoperative MR images and radiographs, and single-level L4–5 TLIF for degenerative spondylolisthesis. Twenty-three patients underwent revision surgery for ASD during the follow-up. Another 23 patients without ASD were matched with the patients with ASD. Demographic data, Roussouly curvature type, and spinopelvic parameter data were collected. The fat infiltration of the LM muscle (L3, L4, and L5) was evaluated on preoperative MRI using the Goutallier classification system.RESULTSA total of 46 patients were evaluated. There were no differences in age, sex, BMI, or spinopelvic parameters with regard to patients with and those without ASD (p > 0.05). Fat infiltration of the LM was significantly greater in the patients with ASD than in those without ASD (p = 0.029). Fat infiltration was most significant at L3 in patients with ASD than in patients without ASD (p = 0.017). At L4 and L5, there was an increasing trend of fat infiltration in the patients with ASD than in those without ASD, but the difference was not statistically significant (p = 0.354 for L4 and p = 0.077 for L5).CONCLUSIONSFat infiltration of the LM may be associated with ASD after L4–5 TLIF for spondylolisthesis. Fat infiltration at L3 may also be associated with ASD at L3–4 after L4–5 TLIF.

Obesity may be associated with adjacent-segment degeneration after single-level transforaminal lumbar interbody fusion in spinopelvic-mismatched patients with a minimum 2-year follow-up

2021 ◽  
Vol 34 (1) ◽  
pp. 83-88
Author(s):  
Ping-Guo Duan ◽  
Praveen V. Mummaneni ◽  
Minghao Wang ◽  
Andrew K. Chan ◽  
Bo Li ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Inclusion Criteria ◽  
Single Level ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Surgery Rates

OBJECTIVEIn this study, the authors’ aim was to investigate whether obesity affects surgery rates for adjacent-segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis.METHODSPatients who underwent single-level TLIF for spondylolisthesis at the University of California, San Francisco, from 2006 to 2016 were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, single-level TLIF, and degenerative lumbar spondylolisthesis. Exclusion criteria were trauma, tumor, infection, multilevel fusions, non-TLIF fusions, or less than a 2-year follow-up. Patient demographic data were collected, and an analysis of spinopelvic parameters was performed. The patients were divided into two groups: mismatched, or pelvic incidence (PI) minus lumbar lordosis (LL) ≥ 10°; and balanced, or PI-LL < 10°. Within the two groups, the patients were further classified by BMI (< 30 and ≥ 30 kg/m2). Patients were then evaluated for surgery for ASD, matched by BMI and PI-LL parameters.RESULTSA total of 190 patients met inclusion criteria (72 males and 118 females, mean age 59.57 ± 12.39 years). The average follow-up was 40.21 ± 20.42 months (range 24–135 months). In total, 24 patients (12.63% of 190) underwent surgery for ASD. Within the entire cohort, 82 patients were in the mismatched group, and 108 patients were in the balanced group. Within the mismatched group, adjacent-segment surgeries occurred at the following rates: BMI < 30 kg/m2, 2.1% (1/48); and BMI ≥ 30 kg/m2, 17.6% (6/34). Significant differences were seen between patients with BMI ≥ 30 and BMI < 30 (p = 0.018). A receiver operating characteristic curve for BMI as a predictor for ASD was established, with an AUC of 0.69 (95% CI 0.49–0.90). The optimal BMI cutoff value determined by the Youden index is 29.95 (sensitivity 0.857; specificity 0.627). However, in the balanced PI-LL group (108/190 patients), there was no difference in surgery rates for ASD among the patients with different BMIs (p > 0.05).CONCLUSIONSIn patients who have a PI-LL mismatch, obesity may be associated with an increased risk of surgery for ASD after TLIF, but in obese patients without PI-LL mismatch, this association was not observed.

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

2018 ◽  
Vol 29 (3) ◽  
pp. 250-258 ◽  
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.

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

2018 ◽  
Vol 29 (4) ◽  
pp. 407-413 ◽  
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.

Early cephalad adjacent segment degeneration after posterior lumbar interbody fusion: a comparative study between cortical bone trajectory screw fixation and traditional trajectory screw fixation

2020 ◽  
Vol 32 (2) ◽  
pp. 155-159 ◽  
Author(s):  
Hironobu Sakaura ◽  
Daisuke Ikegami ◽  
Takahito Fujimori ◽  
Tsuyoshi Sugiura ◽  
Yoshihiro Mukai ◽  
...  
Keyword(s):  
Cortical Bone ◽  
Interbody Fusion ◽  
Screw Fixation ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Disc Height ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Single Level

OBJECTIVECortical bone trajectory (CBT) screw insertion through a caudomedial starting point provides advantages in limiting dissection of the superior facet joints and reducing muscle dissection and the risk of superior-segment facet violation by the screw. These advantages of the cephalad CBT screw can result in lower rates of early cephalad adjacent segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF) with CBT screw fixation (CBT-PLIF) than those after PLIF using traditional trajectory screw fixation (TT-PLIF). Here, the authors investigated early cephalad ASD after CBT-PLIF and compared these results with those after TT-PLIF.METHODSThe medical records of all patients who had undergone single-level CBT-PLIF or single-level TT-PLIF for degenerative lumbar spondylolisthesis (DLS) and with at least 3 years of postsurgical follow-up were retrospectively reviewed. At 3 years postoperatively, early cephalad radiological ASD changes (R-ASD) such as narrowing of disc height (> 3 mm), anterior or posterior slippage (> 3 mm), and posterior opening (> 5°) were examined using lateral radiographs of the lumbar spine. Early cephalad symptomatic adjacent segment disease (S-ASD) was diagnosed when clinical symptoms such as leg pain deteriorated during postoperative follow-up and the responsible lesion suprajacent to the fused segment was confirmed on MRI.RESULTSOne hundred two patients underwent single-level CBT-PLIF for DLS and were followed up for at least 3 years (CBT group). As a control group, age- and sex-matched patients (77) underwent single-level TT-PLIF for DLS and were followed up for at least 3 years (TT group). The total incidence of early cephalad R-ASD was 12.7% in the CBT group and 41.6% in the TT group (p < 0.0001). The incidence of narrowing of disc height, anterior slippage, and posterior slippage was significantly lower in the CBT group (5.9%, 2.0%, and 4.9%) than in the TT group (16.9%, 13.0%, and 14.3%; p < 0.05). Early cephalad S-ASD developed in 1 patient (1.0%) in the CBT group and 3 patients (3.9%) in the TT group; although the incidence was lower in the CBT group than in the TT group, no significant difference was found between the two groups.CONCLUSIONSCBT-PLIF, as compared with TT-PLIF, significantly reduced the incidence of early cephalad R-ASD. One of the main reasons may be that cephalad CBT screws reduced the risk of proximal facet violation by the screw, which reportedly can increase biomechanical stress and lead to destabilization at the suprajacent segment to the fused segment.

scholarly journals Risk of adjacent-segment disease requiring surgery after short lumbar fusion: results of the French Spine Surgery Society Series

2016 ◽  
Vol 25 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Caroline Scemama ◽  
Baptiste Magrino ◽  
Philippe Gillet ◽  
Pierre Guigui
Keyword(s):  
Spine Surgery ◽  
Revision Surgery ◽  
Lumbar Fusion ◽  
Degenerative Spondylolisthesis ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Spinal Disease ◽  
Increased Risk ◽  
Lumbar Spinal

OBJECTIVE Adjacent-segment disease (ASD) is an increasingly problematic complication following lumbar fusion surgery. The purpose of the current study was to determine the risk of ASD requiring surgical treatment after short lumbar or lumbosacral fusion. Primary spinal disease and surgical factors associated with an increased risk of revision were also investigated. METHODS This was a retrospective cohort study using the French Spine Surgery Society clinical data that included 3338 patients, with an average follow-up duration of 7 years (range 4–10 years). Clinical ASD requiring surgery was the principal judgment criterion; the length of follow-up time and initial spinal disease were also recorded. Kaplan-Meier survival analysis was performed. The correlation between primary spinal disease and surgery with an increased risk of revision was investigated. RESULTS During the follow-up period, 186 patients required revision surgery for ASD (5.6%). The predicted risk of ASD requiring revision surgery was 1.7% (95% CI 1.3%–2.2%) at 2 years, 3.8% (95% CI 4.9%–6.7%) at 4 years, 5.7% (95% CI 4.9%–6.7%) at 6 years, and 9% (95% CI 8.7%–10.6%) at 8 years. Initial spinal disease affected the risk of ASD requiring surgery (p = 0.0003). The highest risk was observed for degenerative spondylolisthesis. CONCLUSIONS ASD requiring revision surgery was predicted in 5.6% of patients 7 years after index short lumbar spinal fusion in the French Spine Surgery Society retrospective series. An increased risk of ASD requiring revision surgery associated with initial spinal disease showed the significance of the influence of natural degenerative history on adjacent-segment pathology.

scholarly journals A Minimally Invasive Technique Using Cortical Bone Trajectory Screws Assisted by 3D-Printed Navigation Templates in Lumbar Adjacent Segment Degeneration

2021 ◽  
Author(s):  
Kun He ◽  
Chunke Dong ◽  
Hongyu Wei ◽  
Feng Yang ◽  
Haoning Ma ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Cortical Bone ◽  
Clinical Efficacy ◽  
Revision Surgery ◽  
Operation Time ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
3D Printed

Abstract Background: Revision surgery of adjacent segment degeneration (ASD) commonly need to expose and remove the original fixation. In order to minimize the trauma, reduce the operation time and blood loss, we introduce a minimally invasive lumbar revision technique using cortical bone trajectory (CBT) screws assisted by three-dimensional(3D) printed navigation templates.Methods: From April 2017 to October 2019, 18 patients with ASD underwent revision surgery with CBT screws assisted by 3D-printed templates in our hospital. All the operation data, including operation time, blood loss, incision length were recorded. We evaluated the clinical efficacy using the visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. X-ray and Computed Tomography (CT) scans were used to evaluate the stability of CBT screws fixation, the accuracy of screws, and the fusion rate.Results: The mean follow-up was 22.4±4.7 months (12-31m), the VAS, ODI, and JOA score were analyzed by SPSS 21.0 and showed significant improvement at 2-weeks and the last follow-up compared with preoperative data(P<0.05). 76 CBT screws were inserted with navigation templates, 2 screws were Grade B, other screws were all Grade 0 or A. Changes of intervertebral height showed good stability of CBT screws fixation(P>0.05). All the patients had satisfactory fusion results.Conclusion: Revision surgery of ASD with CBT screws assisted by 3D-printed navigation templates has satisfactory clinical efficacy with advantages of the short operation time, small incision, and less blood loss.

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