Risk Factors of Adjacent Segment Disease After Transforaminal Inter-Body Fusion for Degenerative Lumbar Disease

Yamasaki, Koji; Hoshino, Masahiro; Omori, Keisuke; Igarashi, Hidetoshi; Nemoto, Yasuhiro; Tsuruta, Takashi; Matsumoto, Koji; Iriuchishima, Takanori; Ajiro, Yasumitsu; Matsuzaki, Hiromi

doi:10.1097/brs.0000000000001728

Cited by 78 publications

(46 citation statements)

References 25 publications

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“…The maintenance of spinopelvic alignment is most important for adults with spinal deformity, as this is the primary determinant of life quality after corrective surgery [15] . However, sagittal imbalance reportedly increases the probability of ASD after spinal fusion for LDD [7] . LL is important for maintaining sagittal balance and upright posture.…”

Section: Discussionmentioning

confidence: 97%

“…However, ASD may be caused by natural degeneration of the spine. In addition, patient factors such as older age, obesity, pre-existing ASD, facet degeneration, and lumbar amyotrophy may contribute to the development of ASD [6] .Recent studies have shown that the sagittal spinopelvic balance signi cantly affects the clinical therapy of patients with LBP [7,8] . LDD are often associated with spinopelvic imbalance.…”

Section: Introductionmentioning

confidence: 99%

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Estimation of the Ideal Correction of Lumbar Lordosis to Prevent Reoperation for Symptomatic Adjacent Segment Disease After Lumbar Fusion in Older People

Wang

Zhang

et al. 2020

Preprint

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Abstract Background Symptomatic adjacent segment disease (ASDis) is a major complication following spinal fusion. Sagittal spinopelvic imbalance may contribute to the development of ASDis. However, the exact ideal correction of LL is unknown for different ages of people to prevent ASDis. The purpose of this study was to estimate the ideal correction of lumbar lordosis (LL) required to prevent symptomatic ASDis requiring revision surgery in patients of various ages, and to determine the radiographic risk factors for ASDis.Methods 468 patients who underwent lumbar fusion between January 2014 and December 2016, were enrolled in the present study. The patients were classified into the ASDis and N-ASD group. These two matched groups were compared regarding surgery-related factors and radiographic features. Multivariate logistic regression analysis was used to evaluate the risk factors for ASDis.Results Sixty-two patients (13.25%) underwent reoperation for ASDis during a mean follow-up duration of 38.07 months. Receiver operating characteristic curve analysis showed that the postoperative LL - preoperative LL (△LL) cutoff value was 11.7°for the development of ASDis. Logistic regression analysis revealed that the risk factors for symptomatic ASDis were a smaller LL angle, △LL > 12°, and PI-LL > 10° (p < 0.05). For patients > 60 years, the incidence of ASDis was higher in patients with a LL correction of ≥ 10° and a lumbar-pelvic mismatch (PI-LL) of > 20°.Conclusions The significant predictors of the occurrence of ASD were a smaller LL angle, △LL > 12°, and PI-LL > 10°. However, in patients older than 60 years, the incidence of ASD after lumbar fusion was higher in those with a LL correction of ≥ 10° and PI-LL of > 20°. More attention should be paid to patient age and the angle of correction of LL before lumbar fusion.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Estimation of the Ideal Correction of Lumbar Lordosis to Prevent Reoperation for Symptomatic Adjacent Segment Disease After Lumbar Fusion in Older People

Wang

Zhang

et al. 2020

Preprint

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“…The aim is to relieve clinical symptoms without considering the problem of fixed segment movement. Long-term follow-up reveals adjacent segment ROM increased to compensate for the lost ROM of the fixed segment, resulting in ASD [13][14][15][29][30][31][32][33]. Following improved knowledge of lumbar motion function, surgeons now consider how to treat lumbar degenerative disease while maintaining ROM, and dynamic stabilization has been developed and accepted.…”

Section: Discussionmentioning

confidence: 99%

Is the Interspinous Device (Coflex) Outdated in the Treatment of Lumbar Spinal Stenosis? A Seven-Year Follow-up

Yin¹,

Zheng²,

Gu³

et al. 2018

Spine Research

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Background: Coflex, a kind of dynamic interspinous spacer, has been widely used for the treatment of lumbar spinal stenosis in the past a few years. However, controversy remains as to whether dynamic interspinous spacer use is superior to traditional decompression and fusion surgery. High complication, reoperation rate, and costs with poor outcomes were also mentioned in the literature. The aim of the present study is to evaluate whether Coflex implantation following spinal decompression provided better clinical outcomes compared with traditional decompression and fusion for symptomatic lumbar spinal stenosis through midterm follow-up.

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“…There are several theoretical advantages of fusion techniques, such as restoration of disc height(DH), correction of sagittal spinal balance, and decompression of the neural foramina. [10][11][12] Recently, oblique lumbar interbody fusion (OLIF) is one of the emerging minimally invasive techniques which has progressively been used. The advantages of this minimally invasive technique is avoiding injury to the paraspinal muscles, psoas muscle, and lumbar plexus, owing to it reach the intervertebral space by the retroperitoneal channel directly.…”

Section: Introductionmentioning

confidence: 99%

Lumbar degenerative disease after oblique lateral interbody fusion: sagittal spinopelvic alignment and its impact on low back pain

Zhang

Shen

et al. 2020

Preprint

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Background: The objective of the retrospective study was to investigated the incidence and risk factors of low back pain (LBP) in patients with lumbar degenerative disease after single-level oblique lateral interbody fusion(OLIF).Methods: In this retrospective study, 120 patients who undergoing single-level OLIF to treat lumbar degenerative disease were recruited. Preoperative and postoperative radiographic parameters, including segmental lordosis(SL), lumbar lordosis(LL), disk height(DH), pelvic incidence(PI), pelvic tilt (PT), sacral slope(SS), thoracic kyphosis(TK), C7-sagittal vertical axis (SVA). Visual analog scale(VAS) for back and leg pain, and Oswestry Disability Index(ODI), were used to evaluate symptoms and quantify disability. All patients achieved at least two-year follow-up.Results: A total of 120 Patients who complained low back pain were apportioned to LBP group (n=38; VAS scores for back pain≥3) or Non-LBP group (n=82;VAS scores for back pain＜3). There was no difference in age(P=0.082), gender(P=0.425), body mass index(P=0.138), degenerative spondylolisthesis or lumbar spinal stenosis(P=0.529) surgical level(P=0.651), blood Loss (P=0.889) and operative time(P=0.731) between the groups. In both groups, the ODI and VAS scores for back pain and leg pain were significantly improved at the final follow-up compared to the preoperative scores (P=0.003). Furthermore, except for the LBP (P=0.000), there were no significant differences in these scores between the two groups at the final follow-up (P > 0.05). According to the radiographic parameters, in Non-LBP group, the LL, SL, DH, TK and SS had all significantly improved; PT and C7-SVA significantly decreased at the final follow-up compared to the preoperative values. The DH in both groups had significantly improved, no significant difference was found(P=0.325). In the final follow-up, LL, PI-LL, PT and C7-SVA in Non-LBP group had more improvements compared to the LBP group (P＜0.05) . Multivariate analysis showed that PT, PI-LL and C7-SVA were identified as significant risk factors for LBP after OLIF.Conclusion: The clinical outcomes of OLIF for single-level lumbar degenerative disease were satisfactory. Our findings showed that PT, PI-LL mismatch and C7-SVA had the greatest impact on the incidence of LBP. Therefore, patients with appropriate decreased PT, improved C7-SVA and PI-LL match experienced less low back pain.

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Risk Factors of Adjacent Segment Disease After Transforaminal Inter-Body Fusion for Degenerative Lumbar Disease

Abstract: Patients with preoperative sagittal imbalance have a statistically significant increased risk of ASD. The risk of ASD incidence was 5.1 times greater in subjects with preoperative PT of more than 22.5°.

Cited by 78 publications

References 25 publications

Estimation of the Ideal Correction of Lumbar Lordosis to Prevent Reoperation for Symptomatic Adjacent Segment Disease After Lumbar Fusion in Older People

Estimation of the Ideal Correction of Lumbar Lordosis to Prevent Reoperation for Symptomatic Adjacent Segment Disease After Lumbar Fusion in Older People

Is the Interspinous Device (Coflex) Outdated in the Treatment of Lumbar Spinal Stenosis? A Seven-Year Follow-up

Lumbar degenerative disease after oblique lateral interbody fusion: sagittal spinopelvic alignment and its impact on low back pain

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