Magnetic Resonance Imaging Assessment of Disc Degeneration 10 Years After Anterior Lumbar Interbody Fusion

Penta, Mario; Sandhu, Avninder; Fraser, Robert D.

doi:10.1097/00007632-199503150-00018

Cited by 208 publications

(114 citation statements)

References 0 publications

Supporting

Mentioning

103

Contrasting

Unclassified

Order By: Relevance

“…Whereas many authors have observed ASD [7,20,29,37,39,53], several have not [4,19,28,40,45,48,49], resulting in conflicting conclusions. Furthermore, the clinical implication of a radiologically demonstrated ASD is uncertain.…”

Section: Introductionmentioning

confidence: 99%

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

et al. 2009

View full text Add to dashboard Cite

The existence and importance of an accelerated adjacent segment disc degeneration (ASD) after lumbar fusion have previously not been demonstrated by RCTs. The objectives of this study were, to determine whether lumbar fusion in the long term accelerates degenerative changes in the adjacent disc and whether this affects the outcome, by using a prospective randomised design. A total of 111 patients, aged 18-55, with isthmic spondylolisthesis were randomised to exercise (EX, n = 34) or posterolateral fusion (PLF, n = 77), with (n = 37) or without pedicle screw instrumentation (n = 40). The minimum 10 years FU rate was 72%, with a mean FU time of 12.6 years (range 10-17 years). Three radiographic methods of ASD quantification were used, i.e. two digital radiographic measurement methods and the semi quantitative UCLA grading scale. One digital measurement method showed a mean disc height reduction by 2% in the EX group and by 15% in the PLF group (p = 0.0016), and the other showed 0.5 mm more disc height reduction in the PLF compared to the Ex group (ns). The UCLA grading scale showed normal discs in 100% of patients in the EX group, compared to 62% in the PLF group (p = 0.026). There were no significant differences between instrumented and non-instrumented patients. In patients with laminectomy we found a significantly higher incidence of ASD compared to non laminectomised patients (22/47 vs. 2/16 respectively, p = 0.015). In the longitudinal analysis, the posterior and anterior disc heights were significantly reduced in the PLF group, whereas in the EX group only the posterior disc height was significantly reduced. Except for global outcome, which was significantly better for patients without ASD, the clinical outcome was not statistically different in patients with and without ASD. In conclusion, the long-term RCT shows that fusion accelerates degenerative changes at the adjacent level compared with natural history. The study suggests that not only fusion, but also laminectomy may be of pathogenetic importance. The clinical importance of ASD seems limited, with only the more severe forms affecting the outcome.

show abstract

Section: Introductionmentioning

confidence: 99%

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

et al. 2009

View full text Add to dashboard Cite

show abstract

“…

…”

mentioning

confidence: 99%

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

Kumar¹,

2001

View full text Add to dashboard Cite

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.

show abstract

“…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.…”

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

View full text Add to dashboard Cite

Magnetic Resonance Imaging Assessment of Disc Degeneration 10 Years After Anterior Lumbar Interbody Fusion

Cited by 208 publications

References 0 publications

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

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

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

Contact Info

Product

Resources

About