Long-term Follow-up of Lower Lumbar Fusion Patients

Lehmann, Thomas R.; Spratt, Kevin F.; Tozzi, James E.; Weinstein, James Neil; Reinarz, Stephen J.; el-Khoury, G Y; Colby, Hutha

doi:10.1097/00007632-198703000-00004

Cited by 440 publications

(168 citation statements)

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“…The current thinking is that spinal fusion exerts its longterm effects mainly by inducing adjacent level changes in the spine, particularly at levels suprajacent to the fusion. Increased incidence of degenerative changes at levels adjacent to the fused segment have been reported by many authors [6,8,12,13,22]. The drawbacks present in these studies are summarised in Table 5.…”

Section: Discussionmentioning

confidence: 97%

“…Instability was defined by the criterion of Panjabi and White [24], as sagittal plane translation equal to or more than 25% of the sagittal diameter of the subjacent vertebra. Many studies have used a shift of 3 or 4 mm as the criterion for instability, but this measurement depends on the radiographic magnification and is not reliable unless the latter is kept constant for all patients [6,8,12]. Disc space height was measured using the criteria of Pope et al [18].…”

Section: Methodsmentioning

confidence: 99%

“…Introduction Mobile segment changes above the level of fusion have been reported by many authors [6,8,11,12,13,17], and the level immediately above the fusion is thought to be at high risk due to the altered biomechanics following fusion. Sagittal plane abnormalities caused by fusion, advanced age of the patient and use of rigid pedicle instrumentation have been held responsible for the involvement of levels above the fusion.…”

mentioning

confidence: 99%

“…Most studies that suggest a high incidence of clinically significant adjacent level degeneration have focused only on symptomatic patients [11,22], and have not studied all patients who underwent lumbar fusion. Existing studies that do involve long-term follow-up of patient cohorts following lumbar fusion have certain drawbacks, such as assessment of clinical status using self-reported outcome without validated outcome measurements and performance tests and consideration of radiographic changes alone, without clinical correlation [6,8,12,13,17]. Interpretation of results from these studies is difficult because of differences in the numbers of patients undergoing the different components of evaluation.…”

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confidence: 99%

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Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease

2000

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease

2000

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“…Long-term follow-up studies of noninstrumented posterior lumbar fusions seem to suggest a relatively high incidence of radiographic degenerative changes without significant clinical effects [7,13,22]. However, more recent studies have shown that a significant number of patients with ASD often need re-operation in view of their symptoms [5,25,27,31].…”

Section: Discussionmentioning

confidence: 99%

Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion

Kumar¹,

2001

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IntroductionAdjacent segment degeneration (ASD) has been reported by many authors following lumbar and lumbosacral fusions [1,5,7,9,13,19,21,23,24,26,30,31,32]. In this study the term ASD is used to refer to the onset of degenerative changes in the previously normal disc spaces adjacent to the fusion segment. This becomes symptomatic in many cases and may need re-operation. It is well known that re-operations following lumbar fusions do not always carry good results and that the percentage of good results decreases with each revision surgery [4,11,16]. It is therefore essential to minimize the possibility of re-operation as much as possible. The reasons for adjacent segment degeneration are not fully understood as yet, although various causes have been speculated. The aim of this study is to examine the association of sagittal plane alterations with ASD.Abstract Adjacent segment degeneration following lumbar spine fusion remains a widely acknowledged problem, but there is insufficient knowledge regarding the factors that contribute to its occurrence. The aim of this study is to analyse the relationship between abnormal sagittal plane configuration of the lumbar spine and the development of adjacent segment degeneration. Eightythree consecutive patients who underwent lumbar fusion for degenerative disc disease were reviewed retrospectively. Patients with spondylolytic spondylolisthesis and degenerative scoliosis were not included in this study. Mean follow-up period was 5 years. Results were analysed to determine the association between abnormal sagittal configuration and post operative adjacent segment degeneration. Thirty-one out of 83 patients (36.1%) showed radiographic evidence of adjacent segment degeneration. Patients with normal C7 plumb line and normal sacral inclination in the immediate post operative radiographs had the lowest incidence of adjacent level change compared with patients who had abnormality in one or both of these parameters. The difference was statistically significant (P<0.02). There was no statistically significant difference in the incidence of adjacent level degeneration between male and female patients; between posterior fusion alone and combined posterolateral and posterior interbody fusions; and between fusions extending down to the sacrum and fusions stopping short of the sacrum. It was concluded was that normality of sacral inclination is an important parameter for minimizing the incidence of adjacent level degeneration. Retrolisthesis was the most common type of adjacent segment change. Patients with post operative sagittal plane abnormalities should preferably be followed-up for at least 5 years to detect adjacent level changes.

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A 50-Year-Old Woman With Disabling Spinal Stenosis

Garfin

1995

JAMA

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Long-term Follow-up of Lower Lumbar Fusion Patients

Cited by 440 publications

References 0 publications

Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease

Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease

Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion

A 50-Year-Old Woman With Disabling Spinal Stenosis

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