Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders: a meta-analysis

Abstract

Study design A meta-analysis. Objective We performed a meta-analysis to explore the incidence and risk factors of adjacent segment degeneration (ASD) after posterior lumbar fusion surgery. Methods An extensive search of the literature was performed in English database of PubMed, Embase, and Cochrane Library, and Chinese database of CNKI and WANFANG (up to May 2020). We collected factors including demographic data, surgical factor, and sagittal parameters. Data analysis was conducted with RevMan 5.3 and STATA 12.0. Results Finally, 19 studies were included in the final analysis. In our study, the rate of ASD after posterior lumbar fusion surgery was 18.6% (540 of 2896). Our data also showed that mean age, body mass index (BMI), the history of smoking and hypertension, preoperative adjacent disc degeneration, long-segment fusion, preoperative superior facet violation, high lumbosacral joint angle, pre- and post-operative L1-S1 sagittal vertical axis (SVA), post-operative lumbar lordosis (LL), and preoperative pelvic incidence (PI) were associated with the development of ASD. However, gender, history of diabetes, bone mineral density (BMD), preoperative Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA), the type of fusion (PLIF vs TLIF), type of bone graft (auto- vs allograft), fusion to S1(vs non-fusion to S1), diagnose (lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis), preoperative pelvic tilt (PT), LL and sacral slope (SS), post-operative SS, PT and PI were not associated with the development of ASD. Conclusions In our study, many factors were correlated with the risk of ASD after posterior lumbar fusion surgery. We hope this article can provide a reference for spinal surgeons in treatment for lumbar degenerative diseases.

Bending rod is unnecessary in single-level posterior internal fixation and fusion in treatment of lumbar degenerative diseases

“…In our study, both preoperative and postoperative SS are over 30°, so this change is not an indication of worse clinical outcomes. PI is the sum of SS and PT, and PI itself has been proved to be unrelated to negative results, such as AVD, fracture, screw pulling out and failure [ 21 – 23 ].…”

Impact of patient-specific factors and spinopelvic alignment on the development of adjacent segment degeneration after short-segment lumbar fusion

“…The current literature is controversial about the impact of instrumentation length and level in ASD. (24,35,36) Patients with upper-level lumbar fusions more frequently developed ASD. The reason behind it might be the difference in lumbar segmental range of motions (ROM).…”

“…(38) In the nal model PT was not proved as a risk factor of ASD, which supports nding of the current literature. (24) The lumbar lordosis and its distribution are main aspects in lumbar stabilization surgeries. Patientspeci c optimal amount of lordosis should be constructed and distributed as 50 to 80 percent of the overall lordosis should be in L4-S1 segments as stated by Yilgor at al.…”

“…Possible role of preoperative lumbar degenerative signs and the features of the index surgery were also studied by some authors. (23,24) Majority of studies focused on long lumbar-, thoracolumbar surgeries, and only few papers published the consequence of the most frequent, short-segment lumbar fusions. Despite the multifactorial nature of the condition, most studies have investigated only one or few risk factors, thus the literature lacks of welldesigned multiparametric studies.…”

Comparison between posterior lumbar interbody fusion and transforaminal lumbar interbody fusion in the management of lumbar spondylolisthesis

“…Both transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) have been used in the treatment of DLS (3,4). The goal of spinal fusion operation is to achieve solid arthrodesis of the spinal segments while restoring the disk's height, immobilizing the unstable segment, and restoring the load on the anterior structures (5,6).…”