Risk of adjacent-segment disease requiring surgery after short lumbar fusion: results of the French Spine Surgery Society Series

Scemama, Caroline; Magrino, Baptiste; Gillet, Philippe; Guigui, P.

doi:10.3171/2015.11.spine15700

Cited by 64 publications

(40 citation statements)

References 22 publications

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“…The significance of sagittal balance after posterior lumbar fusion has been shown in several clinical studies. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Oda et al 21 demonstrated that a kyphotic lumbar fusion could lead to degenerative changes in adjacent facet joints.…”

Section: Discussionmentioning

confidence: 99%

Adjacent segment disease after posterior lumbar instrumentation surgery for degenerative disease: Incidence and risk factors

Bagheri

Alimohammadi

Froushani

et al. 2019

J Orthop Surg (Hong Kong)

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To identify risk factors for occurrence of symptomatic adjacent segment disease (ASD) after posterior lumbar instrumentation surgery. Methods: This retrospective study evaluated 630 patients who underwent posterior lumbar transpedicular instrumentation for degenerative lumbar disorders between April 2008 and April 2012. On the basis of developing ASD at follow-up, patients were categorized into two groups: the ASD group and the non-ASD (N-ASD) group. These two groups were compared for patient characteristics, surgical variables, and radiographic parameters to investigate the possible predictive factors of ASD. Results: Of the 630 individuals participated in the study, 76 (12.1%) patients had ASD. Mean and standard deviation of age were 61.37 + 4.12 years for the ASD group and 62.37 + 3.9 for the N-ASD group (p ¼ 0.79). The average follow-up period was 51 + 2.2 months in the ASD group and 52 + 2.3 months in the N-ASD group (p ¼ 0.691). There were no significant differences between the two groups in terms of gender, diabetes mellitus (DM), hypertension, smoking, and osteoporosis, with all p > 0.05. The logistic regression analysis demonstrated that higher preoperative body mass index (BMI; odds ratio (OR) 1.233, p ¼ 0.005), preoperative disc degeneration (OR 1.033, p ¼ 0.024), decreased postoperative lumbar lordosis (OR 3.080, p ¼ 0.011), fusion at more than four levels (OR 4.280, p ¼ 0.014), and intraoperative superior facet joint violation (OR 7.480, p ¼ 0.009) were independently associated with ASD. Conclusions: Patients with higher preoperative BMI, preoperative disc degeneration, decreased postoperative lumbar lordosis, fusion at more than four levels, and intraoperative superior facet joint violation have a statistically significant increased risk of developing ASD.

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Section: Discussionmentioning

confidence: 99%

Adjacent segment disease after posterior lumbar instrumentation surgery for degenerative disease: Incidence and risk factors

Bagheri

Alimohammadi

Froushani

et al. 2019

J Orthop Surg (Hong Kong)

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“…To achieve effective fusion with an interbody cage, supplemented internal fixation is often used. As pedicle screw-rod instrumentation becomes more widespread, spine surgeons are inevitably faced with a growing number of patients presenting with symptomatic adjacent segment degeneration (ASD) [2][3][4][5]. The incidence of symptomatic ASD ranges from 5.2 to 18.5%, as reported by Park et al [6].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of strategies for adjacent segment disease after lateral lumbar interbody fusion: is the extension of pedicle screws necessary?

Liang

Cui

Zhang

et al. 2020

BMC Musculoskelet Disord

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Background: Adjacent segment disease (ASD) is a well-known complication after interbody fusion. Pedicle screwrod revision possesses sufficient strength and rigidity. However, is a surgical segment with rigid fixation necessary for ASD reoperation? This study aimed to investigate the biomechanical effect of different instrumentation on lateral lumbar interbody fusion (LLIF) for ASD treatment. Methods: A validated L2~5 finite element (FE) model was modified for simulation. ASD was considered the level cranial to the upper-instrumented segment (L3/4). Bone graft fusion in LLIF with bilateral pedicle screw (BPS) fixation occurred at L4/5. The ASD segment for each group underwent a) LLIF + posterior extension of BPS, b) PLIF + posterior extension of BPS, c) LLIF + lateral screw, and d) stand-alone LLIF. The L3/4 range of motion (ROM), interbody cage stress and strain, screw-bone interface stress, cage-endplate interface stress, and L2/3 nucleus pulposus of intradiscal pressure (NP-IDP) analysis were calculated for comparisons among the four models. Results: All reconstructive models displayed decreased motion at L3/4. Under each loading condition, the difference was not significant between models a and b, which provided the maximum ROM reduction (73.8 to 97.7% and 68.3 to 98.4%, respectively). Model c also provided a significant ROM reduction (64.9 to 77.5%). Model d provided a minimal restriction of the ROM (18.3 to 90.1%), which exceeded that of model a by 13.1 times for flexion-extension, 10.3 times for lateral bending and 4.8 times for rotation. Model b generated greater cage stress than other models, particularly for flexion. The maximum displacement of the cage and the peak stress of the cageendplate interface were found to be the highest in model d under all loading conditions. For the screw-bone interface, the stress was much greater with lateral instrumentation than with posterior instrumentation.

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“…L5 is the most frequent lesion level for lumbar spondylolysis [10]. The union rate of L5 lesions is lower than that for other levels [11,12].…”

Section: Discussionmentioning

confidence: 96%

Factors Associated with Failure of Bony Union After Conservative Treatment of Acute Cases of Unilateral Lumbar Spondylolysis

Tatsumura

Gamada

Okuwaki

et al. 2020

Preprint

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Background: If bone union is expected, conservative treatment is generally selected for lumbar spondylolysis. However, sometimes conservative treatments are unsuccessful. We sought to determine the factors associated with failure of bony union in acute unilateral lumbar spondylolysis with bone marrow edema including contralateral pseudoarthrosis.Methods: This study targeted unilateral lumbar spondylolysis treated conservatively in high school or younger students. Conservative therapy was continued until the bone marrow edema disappeared on MRI and bone union was investigated by CT. We conducted a univariate analysis of sex, age, pathological stage, lesion level complicating the contralateral bone defect, lesion level, and intercurrent spina bifida occulta, and variables with p < 0.1 were considered in a logistic regression analysis. An item with p < 0.05 was defined as a factor associated with failure of bony union.Results: We found 92 cases of unilateral spondylolysis with bone marrow edema and 66 cases were successfully treated conservatively. Failure of bony union in unilateral lumbar spondylolysis with bone marrow edema was associated with advanced pathological stage (p = 0.004), contralateral pseudoarthrosis (p < 0.001), and L5 lesion level (p = 0.002). The odds ratio was 20.0 (95% CI 3.0–193.9) for advanced pathological stage, 78.8 (95% CI 13–846) for contralateral pseudoarthrosis, and 175 (95% CI 8.5–8192) for L5 lesion level.Conclusions: Conservative therapy aiming at bony union is contraindicated in cases of acute unilateral spondylolysis when the pathological stage is advanced, the lesion level is L5, or there is contralateral pseudoarthrotic spondylolysis.

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Risk of adjacent-segment disease requiring surgery after short lumbar fusion: results of the French Spine Surgery Society Series

Cited by 64 publications

References 22 publications

Adjacent segment disease after posterior lumbar instrumentation surgery for degenerative disease: Incidence and risk factors

Adjacent segment disease after posterior lumbar instrumentation surgery for degenerative disease: Incidence and risk factors

Biomechanical evaluation of strategies for adjacent segment disease after lateral lumbar interbody fusion: is the extension of pedicle screws necessary?

Factors Associated with Failure of Bony Union After Conservative Treatment of Acute Cases of Unilateral Lumbar Spondylolysis

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