Preliminary Results on Radiological Hypermobility at Upper Adjacent Disc Level in Posterior Lumbar Interbody Fusion Compared to Advanced Dynamic Stabilization

Abstract

Whether posterior lumbar interbody fusion (PLIF) is effective in patients older than 55 years remains questionable because of the high prevalence of adjacent segment disease. We retrospectively investigated early clinical outcomes and radiological changes at upper adjacent disc (UAD) level in such age-group patients who underwent advanced dynamic stabilization (ADS) or PLIF. ADS or PLIF were performed in patients with grade 1 spondylolisthesis or disc degeneration complicated by apparent vacuum phenomenon. All patients suffered from neurological symptoms in lower limbs with/without low back pain. In all, 16 patients (six females; mean age, 69.0 ± 8.5 years) who underwent ADS and 14 patients (seven females; mean age, 67.8 ± 9.3 years) who underwent PLIF were followed-up, and preoperative and postoperative final disc height (DH) and range of motion (ROM) were investigated retrospectively using dynamic radiography at the operated and UAD levels. Clinical data of patients who underwent ADS and PLIF were as follows: postoperative follow-up, 459.3 ± 263.5 and 507.7 ± 288.3 days; preoperative Japanese Orthopaedic Association (JOA) score, 14.4 ± 4.1 and 13.4 ± 4.5; and recovery rate of JOA score, 67.5 ± 18.5 and 50.1 ± 23.4%, respectively. Recovery rate of JOA score in ADS group was significantly high compared to PLIF group (P = 0.044). At UAD level, ROM decreased from 4.7 ± 2.9° preoperatively to 3.6 ± 2.6° postoperatively in the ADS group and increased from 3.4 ± 4.1° preoperatively to 5.6 ± 2.8° postoperatively with significant hypermobility (P = 0.020) in the PLIF group. ADS has the advantage in clinical outcomes even in the postoperative early stage, avoiding the early hypermobility at UAD level, compared to PLIF in patients older than 55 years.

Determining a relative total lumbar range of motion to alleviate adjacent segment degeneration after transforaminal lumbar interbody fusion: a finite element analysis

“…Poor sagittal balance, however, was only a limited risk factor for ASD revisions in the study by Toivonen et al [ 45 ]. To reduce the risk of ASD, researchers have developed many dynamic and semirigid fixation devices to preserve spinal movement and distribute the load reasonably [ 46 , 47 ]. However, the effectiveness of these devices has been questioned.…”

Relationship between Preoperative Neuroradiological Findings and Intraoperative Bulbocavernosus Reflex Amplitude in Patients with Intradural Extramedullary Tumors

“…Recently, the safety of spinal surgery has improved with the advancement of surgical methods and equipment. [1][2][3] However, the procedure is associated with high risk of intraoperative injury, with a major complication rate of 3.3% within 30 days postoperatively. 4) In particular, lumbar surgery may cause bladder and rectal disorders due to sacral cord and cauda equina (CE) injuries and sensorimotor disturbance.…”