Lumbar Motion Segment Pathology Adjacent to Thoracolumbar, Lumbar, and Lumbosacral Fusions

Schlegel, John D.; Smith, Jason A.; Schleusener, Rand L.

doi:10.1097/00007632-199604150-00013

Cited by 423 publications

(213 citation statements)

References 29 publications

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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: 96%

“…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. 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].…”

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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: 96%

mentioning

confidence: 99%

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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“…However, to solve the complication of ASD several flexible or even dynamic devices have been used with controversial results [17,43,50,52]. It has been proposed that non-fusion motion preservation surgery may prevent accelerated ASD because of the protective effects of continuing segmental motion.…”

Section: Discussionmentioning

confidence: 99%

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

et al. 2009

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Delayed complications following lumbar spine fusion may occur amongst which is adjacent segment degeneration (ASD). Although interspinous implants have been successfully used in spinal stenosis to authors' knowledge such implants have not been previously used to reduce ASD in instrumented lumbar fusion. This prospective controlled study was designed to investigate if the implantation of an interspinous implant cephalad to short lumbar and lumbosacral instrumented fusion could eliminate the incidence of ASD and subsequently the related reoperation rate. Groups W and C enrolled initially each 25 consecutive selected patients. Group W included patients, who received the Wallis interspinous implant in the unfused vertebral segment cephalad to instrumentation and the group C selected age-, diagnosis-, level-, and instrumentationmatched to W group patients without interspinous implant (controls). The inclusion criterion for Wallis implantation was UCLA arthritic grade \II, while the exclusion criteria were previous lumbar surgery, severe osteoporosis or degeneration[UCLA grade II in the adjacent two segments cephalad to instrumentation. All patients suffered from symptomatic spinal stenosis and underwent decompression and 2-4 levels stabilization with rigid pedicle screw fixation and posterolateral fusion by a single surgeon. Lumbar lordosis, disc height (DH), segmental range of motion (ROM), and percent olisthesis in the adjacent two cephalad to instrumentation segments were measured preoperatively, and postoperatively until the final evaluation. VAS, SF-36, and Oswestry Disability Index (ODI) were used. One patient of group W developed pseudarthrosis: two patients of group C deep infection and one patient of group C ASD in the segment below instrumentation and were excluded from the final evaluation. Thus, 24 patients of group W and 21 in group C aged 65? 13 and 64? 11 years, respectively were included in the final analysis. The follow-up averaged 60 ± 6 months. The instrumented levels averaged 2.5 ? 1 vertebra for both groups. All 45 spines showed radiological fusion 8-12 months postoperatively. Lumbar lordosis did not change postoperatively. Postoperatively at the first cephalad adjacent segment: DH increased in the group W (P = 0.042); ROM significantly increased only in group C (ANOVA, P \ 0.02); olisthesis decreased both in flexion (P = 0.0024) and extension (P = 0.012) in group W. The degeneration or deterioration of already existed ASD in the two cephalad segments was shown in 1 (4.1%) and 6 (28.6%) spines in W and C groups, respectively. Physical function (SF-36) and ODI improved postoperatively (P \ 0.001), but in favour of the patients of group W (P \ 0.05) at the final evaluation. Symptomatic ASD required surgical intervention was in 3 (14%) patients of group C and none in group W. ASD remains a significant problem and accounts for a big portion of revision surgery following instrumented lumbar fusion. In this series, the Wallis interspinous implant changed the natural history of ASD and saved th...

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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]. It is known that re-operations following spinal fusion do not always carry a good prognosis and the success rate seems to decrease with each successive surgical intervention [4,11,16].…”

Section: Discussionmentioning

confidence: 99%

“…There are very few studies on the role of alteration of sagittal plane anatomy in contributing to ASD [19,27]. Lazennec et al [18] showed a statistically significant correlation between reduction of sacral inclination and back pain following lumbosacral fusion.…”

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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Lumbar Motion Segment Pathology Adjacent to Thoracolumbar, Lumbar, and Lumbosacral Fusions

Cited by 423 publications

References 29 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

Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion?

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

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