Adjacent Segment Degeneration After Lumbar Interbody Fusion With Percutaneous Pedicle Screw Fixation for Adult Low-Grade Isthmic Spondylolisthesis: Minimum 3 Years of Follow-up

Bae, Jun Seok; Lee, Sang-Ho; Kim, Jin-Sung; Jung, Byungjoo; Choi, Gun

doi:10.1227/neu.0b013e3181f91697

Cited by 87 publications

(81 citation statements)

References 32 publications

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“…This is why further use of this method seems acceptable. The finding of a more intact segmental lordosis than with PLIF is novel information and might favor PLF contra interbody fusions or as in the case of PLIF it might suffice with PLF without interbody fusion [43,44]. Future studies should examine whether surgically increased disc height correlates with clinical results.…”

Section: Resultsmentioning

confidence: 99%

“…The literature has been slightly contradictive on this matter, but the common opinion tends to acknowledge this phenomenon [37][38][39][40][41][42][43][44]. When the primary surgical goal with fusion is attained, segmental motion is almost reduced to zero, which is believed to reduce or relieve back pain.…”

mentioning

confidence: 99%

“…Physiological motion is then transferred to adjacent segments, which might accelerate DDD in those segments and give rise to ASD [41,45]. If lordosis can be restored or at least kyphosis inhibited in the treated segment, the risk of ASD can be reduced [43,44].…”

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confidence: 99%

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Maintenance of Disc Height and Lordosis When Performing a New Technique In Instrumented Lumbar Posterolateral Fusion - Results from a Consecutive Prospective Study

Dahlemar¹

2013

J Spine

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Study Design: Consecutive Prospective Study. Summary of Background Data:Lumbar fusion is considered the "gold standard" treatment for chronic low back pain (CLBP) that is believed to be due to degenerative disc disease (DDD) and is not relieved by prolonged conservative treatment. Instrumented intercorporal fusion is believed to restore disc height and prevent postoperative kyphosis better than instrumented posterolateral fusion (PLF). A new technique to perform PLF, using modern pedicle screw systems, challenges this belief.Objective: This study has two main objectives: to measure disc height and segmental lordosis pre-, post-, and late post-operative in patients operated on with a variant of PLF and to compare the results with reported measurements with other techniques. Material:The study included 97 consecutive patients (56 female) age 20-73, all with CLBP; 84 patients were diagnosed as DDD only, 13 patients had a spondylolisthesis with concurrent DDD. Forty-nine, patients were treated at one segment, 47 at two segments, and one patient at three segments. All patients were X-rayed preoperatively, immediately post-operative, and at late follow-up (≥ 10 months). Methods:In all patients, PLF's were performed using a pretension-distraction technique. Disc height and lordosis were calculated for all treated segments according to evaluated methods. The values on disc height and lordosis were compared for each patient preoperatively, immediately post-operative, and at follow-up.Results: All treated segments had an increase of disc height at post-operative examinations. Despite some reduction of this increase at late control follow-up, the increase was still significant for L3-L4 segment (men) and L4-L5 and L5-S1 segments (women). Lordosis was reduced postoperatively with less than the measurement error for the method.Conclusions: When this method of PLF was used, long-term increase in disc height and maintenance of lordosis was as favorable as reported on intercorporal fusions.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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Maintenance of Disc Height and Lordosis When Performing a New Technique In Instrumented Lumbar Posterolateral Fusion - Results from a Consecutive Prospective Study

Dahlemar¹

2013

J Spine

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“…Adjacent segmental degeneration (ASD) was diagnosed when plain radiographs demonstrated one or more of the following at the segment adjacent to the fused segment that were not present preoperatively: more than 4 mm of anterolisthesis or retrolisthesis, more than 10 degrees of angular motion between adjacent vertebral bodies on flexion and extension radiographs, spinal stenosis caused by facet joint hypertrophy, degenerative scoliosis, more than 10% loss of disc height, and more than 3 mm of osteophyte formation (3,16,20).…”

Section: Tang S Et Al: Anterior Lumbar Interbody Fusionmentioning

confidence: 99%

Anterior lumbar interbody fusion combined with percutaneous pedicle screw fixation for degenerative lumbar instability: minimum four-year follow-up

Tang¹,

Xu²,

Rebholz³

2011

Turkish Neurosurgery

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AIm: Our goal was to investigate the long-term results of anterior lumbar interbody fusion combined with percutaneous pedicle screw fixation for degenerative lumbar instability. mAterIAl and methOds: Forty-seven patients that had undergone anterior lumbar interbody fusion combined with percutaneous pedicle screw fixation for degenerative lumbar instability at Tianjin Hospital between May 2003 and January 2007 were reviewed retrospectively. Radiographic results including the fusion rate, disc space height, segmental lordosis and whole lumbar lordosis were analyzed, and clinical outcomes were assessed using the Japanese Orthopaedic Association score. results:In 47 patients, no surgery-related neurological deficit or wound breakdown was observed and 45 patients obtained a solid fusion. The mean JOA score increased significantly (p<0.05) from 9.4 before surgery to 24.6 six months after surgery and 26.1 at final follow-up. The disc space height, segmental lordosis and whole lumbar lordosis increased significantly from pre-operative values to both six months postoperatively (p<0.05) and at the final follow up (p<0.05). Radiographic evidence of adjacent segmental degeneration was found in 14 patients (29.8%) and symptomatic adjacent segmental disease developed in 1 patient (2.1%).COnClusIOn: Anterior lumbar interbody fusion combined with percutaneous pedicle screws fixation in patients with degenerative lumbar instability results in good clinical and radiographic outcomes at long-term follow-up. BulGulAr: Hastaların 45'inde güçlü füzyon gelişti. Hastaların hiçbirinde yara yeri ile ilgili sorun olmadı, ayrıca cerrahiye ikincil olarak gelişen nörolojik hasar saptanmadı. JOA skorları cerrahi öncesine göre istatiksel olarak anlamlı ölçüde arttı (p<0,05) 9,4, önce 24,6 -26,1. Disk aralığı yüksekliği ve segmental lordoz ve tüm lordoz açıları istatiksel olarak anlamlı ölçüde arttı (p<0,05). Hastaların 14'ünde ( %29,8) komşu segmentte dejenerasyon görülürken, hastaların 1'inde (%2,1) komşu segment hastalığı gözlendi. sOnuÇ: Perkütan yoldan yapılan pedikül vidalaması ile anterior yoldan yapılan lomber intervertebral füzyonun dejeneratif lomber instabilitede klinik ve radyolojik olarak uzun dönemli sonuçları iyi olarak bulunmuştur.

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“…These include a more morbidity-producing operative intervention, loss of segmental motion, increased stress on adjacent levels, fusion into suboptimal alignment, 14,15,26 and all of the typical complications associated with fusion and instrumentation, such as pseudarthrosis and hardware problems. 1,3,28 In some patients only symptoms of neural compression will be seen. For these patients decompression without fusion remains a possibility.…”

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confidence: 99%

Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis

Madhavan

Chieng

Hofstetter

et al. 2016

FOC

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Isthmic spondylolisthesis due to pars defects resulting from trauma or spondylolysis is not uncommon. Symptomatic patients with such pars defects are traditionally treated with a variety of fusion surgeries. The authors present a unique case in which such a patient was successfully treated with endoscopic discectomy without iatrogenic destabilization. A 31-year-old man presented with a history of left radicular leg pain along the distribution of the sciatic nerve. He had a disc herniation at L5/S1 and bilateral pars defects with a Grade I spondylolisthesis. Dynamic radiographic studies did not show significant movement of L-5 over S-1. The patient did not desire to have a fusion. After induction of local anesthesia, the patient underwent an awake transforaminal endoscopic discectomy via the extraforaminal approach, with decompression of the L-5 and S-1 nerve roots. His preoperative pain resolved immediately, and he was discharged home the same day. His preoperative Oswestry Disability Index score was 74, and postoperatively it was noted to be 8. At 2-year follow-up he continued to be symptom free, and no radiographic progression of the listhesis was noted. In this case preservation of stabilizing structures, including the supraspinous and interspinous ligaments and the facet capsule, may have reduced the likelihood of iatrogenic instability while at the same time achieving symptom control. This may be a reasonable option for select patient symptoms confined to lumbosacral radiculopathy.

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Adjacent Segment Degeneration After Lumbar Interbody Fusion With Percutaneous Pedicle Screw Fixation for Adult Low-Grade Isthmic Spondylolisthesis: Minimum 3 Years of Follow-up

Cited by 87 publications

References 32 publications

Maintenance of Disc Height and Lordosis When Performing a New Technique In Instrumented Lumbar Posterolateral Fusion - Results from a Consecutive Prospective Study

Maintenance of Disc Height and Lordosis When Performing a New Technique In Instrumented Lumbar Posterolateral Fusion - Results from a Consecutive Prospective Study

Anterior lumbar interbody fusion combined with percutaneous pedicle screw fixation for degenerative lumbar instability: minimum four-year follow-up

Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis

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