Additional decompression at adjacent segments leads to adjacent segment degeneration after PLIF

Miyagi, Masayuki; Ikeda, Osamu; Ohtori, Seiji; Tsuneizumi, Yoshikazu; Someya, Yuichi; Shibayama, Masataka; Ogawa, Yoshitsugu; Inoue, Gen; Orita, Sumihisa; Eguchi, Yawara; Kamoda, Hiroto; Arai, Gen; Ishikawa, Tetsuhiro; Aoki, Yasuchika; Toyone, Tomoaki; Ooi, Toshio; Takahashi, Kazuhisa

doi:10.1007/s00586-013-2694-8

Cited by 29 publications

(22 citation statements)

References 44 publications

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“…Although many scholars pay more attention to ASD after spine surgery, the risk factors associated with ASD are controversial. Thus, we perform a meta-analysis to evaluate the risk factors associated with ASD [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. The rate of ASD after posterior lumbar fusion surgery was 18.6% (ranged from 8.5 to 69.4%) in this study.…”

Section: Discussionmentioning

confidence: 99%

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

Wang

Ding

2020

J Orthop Surg Res

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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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Section: Discussionmentioning

confidence: 99%

“…Fifteen studies (2592 of 2896 patients) [12,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] reported gender between ASD group and non-ASD group. There was no significance in the test for heterogeneity and the studies had low heterogeneity (p for heterogeneity = 0.89; I 2 = 0%, Fig.…”

Section: Gendermentioning

confidence: 99%

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

Wang

Ding

2020

J Orthop Surg Res

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“…However, more researchers held the opposite view that simultaneous decompression without fusion at the adjacent segments was futile or, even worse, that there was a possibility that it would induce ASD. 8,22 Clinging to the belief that disrupting the integrity of posterior spinal elements can jeopardize lumbar spine stability, we eliminated this option in all cases.…”

Section: Discussionmentioning

confidence: 99%

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

Han¹,

Sun²,

Luo³

et al. 2016

SPI

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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.

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“…On the other hand, in this study, there were no cases that had pain recurrence (and required revision surgery) due to the recurrence of disc herniation or other segment disorders including adjacent segment degenerations within one-year follow-up. Generally, an adjacent segment degeneration after lumbar interbody fusion surgery mainly occurs at a long-term period of over 2 years after surgery [ 24 ]. Thus, the effect of other segment diseases to ROM levels is basically eliminated in this study.…”

Section: Discussionmentioning

confidence: 99%

Time Course of Changes in Serum Oxidative Stress Markers to Predict Outcomes for Surgical Treatment of Lumbar Degenerative Disorders

Takahashi

Aoki

Saito

et al. 2020

Oxidative Medicine and Cellular Longevity

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Recent reports indicate that oxidative stress is involved in the pathobiology of acute spinal cord injury or compression myelopathy. We conducted an observational study to determine levels of oxidative stress markers in serum from 80 patients who underwent spinal surgery to treat neurological symptoms related to lumbar degenerative disorders. Serum samples were collected before surgery and at 3 months, 6 months, and 1 year after surgery. Derivatives of reactive oxygen metabolites (ROM) in the serum samples were measured to gauge the level of oxidative stress. For preoperative neurological evaluation, patients were assessed for motor weakness in the lower extremities. We divided the patient samples into two groups: ROM decreasing at 1 year after surgery (G group) and ROM increasing at 1 year after surgery (W group). Then, we evaluated clinical outcomes using the visual analog scale and Oswestry disability index (ODI). Among the samples from the 80 enrolled patients, mean ROM levels before surgery increased to 388.5 ± 92.0 , indicating the presence of moderate oxidative stress. The level of ROM gradually decreased after surgery and 1 year after surgery: the levels had significantly decreased to 367.6 ± 83.3 ( p < 0.05 ). In patients who exhibited motor weakness, ROM values were significantly increased compared to those patients who had no motor weakness ( p < 0.05 ). In analyses of clinical outcomes, ODI values for the W group 1 year after surgery were significantly higher than those for the G group ( p < 0.05 ). Moderate oxidative stress was present in patients who had lumbar degenerative disorders and the degree of oxidative stress gradually improved within 1 year after surgery. The clinical results suggest that neurogenic oxidative stress can be mitigated by surgery for patients with lumbar degenerative disorders, and residual oxidative stress reflects poor surgical outcomes.

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Additional decompression at adjacent segments leads to adjacent segment degeneration after PLIF

Cited by 29 publications

References 44 publications

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

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

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

Time Course of Changes in Serum Oxidative Stress Markers to Predict Outcomes for Surgical Treatment of Lumbar Degenerative Disorders

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