scholarly journals Lumbar Stabilization with DSS-HPS® System: Radiological Outcomes and Correlation with Adjacent Segment Degeneration

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1891
Author(s):  
Andrea Angelini ◽  
Riccardo Baracco ◽  
Alberto Procura ◽  
Ugo Nena ◽  
Pietro Ruggieri
Keyword(s):  
Disc Degeneration ◽  
Adjacent Segment Degeneration ◽  
Disc Height ◽  
Adjacent Segment ◽  
Segmental Motion ◽  
Adjacent Level ◽  
Fusion Surgery ◽  
Lumbar Stabilization ◽  
Degenerative Lumbar Disease ◽  
Segmental Angle

Arthrodesis has always been considered the main treatment of degenerative lumbar disease. Adjacent segment degeneration is one of the major topics related to fusion surgery. Non-fusion surgery may prevent this because of the protective effect of persisting segmental motion. The aims of the study were (1) to describe the radiological outcomes in the adjacent vertebral segment after lumbar stabilization with DSS-HPS® system and (2) to verify the hypothesis that this system prevents the degeneration of the adjacent segment. This is a retrospective monocentric analysis of twenty-seven patients affected by degenerative lumbar disease underwent spinal hybrid stabilization with the DSS-HPS® system between January 2016 and January 2019. All patients completed 1-year radiological follow-up. Preoperative X-rays and magnetic resonance images, as well as postoperative radiographs at 1, 6 and 12 months, were evaluated by one single observer. Pre- and post-operative anterior and posterior disc height at the dynamic (DL) and adjacent level (AL) were measured; segmental angle (SA) of the dynamized level were measured. There was a statistically significant decrease of both anterior (p = 0.0003 for the DL, p = 0.036 for the AL) and posterior disc height (p = 0.00000 for the DL, p = 0.00032 for the AL); there were a statistically significant variations of the segmental angle (p = 0.00000). Eleven cases (40.7%) of radiological progression of disc degeneration were found. The DSS-HPS® system does not seem to reduce progression of lumbar disc degeneration in a radiologic evaluation, both in the dynamized and adjacent level.

scholarly journals Comparison of pedicle screw–based dynamic stabilization and fusion surgery in the treatment of radiographic adjacent-segment degeneration: a retrospective analysis of single L5–S1 degenerative spondylosis covering 4 years

2016 ◽  
Vol 25 (6) ◽  
pp. 706-712 ◽  
Author(s):  
Yu Han ◽  
Jianguang Sun ◽  
Chenghan Luo ◽  
Shilei Huang ◽  
Liren Li ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Spinopelvic Parameters ◽  
Fusion Surgery ◽  
Spinal Stabilization ◽  
Pfirrmann Grade

OBJECTIVE Pedicle screw–based dynamic spinal stabilization systems (PDSs) were devised to decrease, theoretically, the risk of long-term complications such as adjacent-segment degeneration (ASD) after lumbar fusion surgery. However, to date, there have been few studies that fully proved that a PDS can reduce the risk of ASD. The purpose of this study was to examine whether a PDS can influence the incidence of ASD and to discuss the surgical coping strategy for L5–S1 segmental spondylosis with preexisting L4–5 degeneration with no related symptoms or signs. METHODS This study retrospectively compared 62 cases of L5–S1 segmental spondylosis in patients who underwent posterior lumbar interbody fusion (n = 31) or K-Rod dynamic stabilization (n = 31) with a minimum of 4 years' follow-up. The authors measured the intervertebral heights and spinopelvic parameters on standing lateral radiographs and evaluated preexisting ASD on preoperative MR images using the modified Pfirrmann grading system. Radiographic ASD was evaluated according to the results of radiography during follow-up. RESULTS All 62 patients achieved remission of their neurological symptoms without surgical complications. The Kaplan-Meier curve and Cox proportional-hazards model showed no statistically significant differences between the 2 surgical groups in the incidence of radiographic ASD (p > 0.05). In contrast, the incidence of radiographic ASD was 8.75 times (95% CI 1.955–39.140; p = 0.005) higher in the patients with a preoperative modified Pfirrmann grade higher than 3 than it was in patients with a modified Pfirrmann grade of 3 or lower. In addition, no statistical significance was found for other risk factors such as age, sex, and spinopelvic parameters. CONCLUSIONS Pedicle screw–based dynamic spinal stabilization systems were not found to be superior to posterior lumbar interbody fusion in preventing radiographic ASD (L4–5) during the midterm follow-up. Preexisting ASD with a modified Pfirrmann grade higher than 3 was a risk factor for radiographic ASD. In the treatment of degenerative diseases of the lumbosacral spine, the authors found that both of these methods are feasible. Also, the authors believe that no extra treatment, other than observation, is needed for preexisting degeneration in L4–5 without any clinical symptoms or signs.

Longer Plate-to-Disc Distance Prevents Adjacent-Level Ossification Development But Does Not Influence Adjacent-Segment Degeneration

Spine ◽  
2015 ◽  
Vol 40 (7) ◽  
pp. E388-E393 ◽  
Author(s):  
Haisong Yang ◽  
Xuhua Lu ◽  
Hailong He ◽  
Wen Yuan ◽  
Xinwei Wang ◽  
...  
Keyword(s):  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Adjacent Level

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.

Biomechanical Changes at Adjacent-Level Segments After Anterior Cervical Discectomy and Fusion

2003 ◽  
Author(s):  
R. N. Natarajan ◽  
G. B. J. Andersson ◽  
H. S. An
Keyword(s):  
Adjacent Segment Degeneration ◽  
Anterior Cervical Discectomy ◽  
Adjacent Segment ◽  
Exact Nature ◽  
Adjacent Level ◽  
Cervical Discectomy ◽  
Upper Cervical ◽  
Biomechanical Changes ◽  
Level Fusion ◽  
Element Study

It is well documented that there is significant motion in the unfused segments above and below a fused segment during anterior cervical discectomy and fusion but exact nature of this motion is not well known. The current finite element study showed that likelihood of adjacent segment degeneration is higher in a two level fusion than a one level fusion. Also, the analyses showed that two level fusion at upper cervical levels more likely to degenerate above and below than two level fusion at lower cervical levels.

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.

Adjacent Segment Degeneration After Anterior Cervical Discectomy and Fusion With an Autologous Iliac Crest Graft: A Magnetic Resonance Imaging Study of 59 Patients With a Mean Follow-up of 27 Years

Neurosurgery ◽  
2017 ◽  
Vol 82 (6) ◽  
pp. 799-807 ◽  
Author(s):  
Benedikt W Burkhardt ◽  
Andreas Simgen ◽  
Gudrun Wagenpfeil ◽  
Wolfgang Reith ◽  
Joachim M Oertel
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Adjacent Segment Degeneration ◽  
Disc Height ◽  
Adjacent Segment ◽  
Resonance Imaging ◽  
Physiological Aging ◽  
Repeat Procedure ◽  
Adjacent Segments

Abstract BACKGROUND Anterior cervical decompression and fusion (ACDF) is a widely accepted surgical technique for the treatment of degenerative disc disease. ACDF is associated with adjacent segment degeneration (ASD). OBJECTIVE To assess whether physiological aging of the spine would overcome ASD by comparing adjacent to adjoining segments more than 18 yr after ACDF. METHODS Magnetic resonance imaging of 59 (36 male, 23 female) patients who underwent ACDF was performed to assess degeneration. The mean follow-up was 27 yr (18-45 yr). Besides measuring the disc height, a 5-step grading system (segmental degeneration index [SDI]) including disc signal intensity, anterior and posterior disc protrusion, narrowing of the disc space, and foraminal stenosis was used to assess the grade of adjacent and adjoining segments. RESULTS The SDI of cranial and caudal adjacent segments was significantly higher compared to adjoining segments (P &lt; .001). The disc height of cranial and caudal adjacent segments was significantly lower compared to adjoining segments (P &lt; .001, P &lt; .01). The SDI of adjacent segments in patients with repeat cervical procedure was significantly higher than in patients without repeat procedure (P = .02, P = .01). The disc height of the cranial adjacent segments in patients with repeat procedure was significantly lower than in patients without repeat procedure (P = .01). CONCLUSION The physiological aging of the cervical spine does not overcome ASD. The disc height and the SDI in adjacent segment are significantly worse compared to adjoining segments. Patients who underwent repeat procedure had even worse findings of disc height and SDI.

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