Survival and Prognostic Analysis of Adjacent Segments after Spinal Fusion

Abstract

BackgroundTo examine the survival function and prognostic factors of the adjacent segments based on a second operation after thoracolumbar spinal fusion.MethodsThis retrospective study reviewed 3,188 patients (3,193 cases) who underwent a thoracolumbar spinal fusion at the author's hospital. Survival analysis was performed on the event of a second operation due to adjacent segment degeneration. The prognostic factors, such as the cause of the disease, surgical procedure, age, gender and number of fusion segments, were examined. Sagittal alignment and the location of the adjacent segment were measured in the second operation cases, and their association with the types of degeneration was investigated.ResultsOne hundred seven patients, 112 cases (3.5%), underwent a second operation due to adjacent segment degeneration. The survival function was 97% and 94% at 5 and 10 years after surgery, respectively, showing a 0.6% linear reduction per year. The significant prognostic factors were old age, degenerative disease, multiple-level fusion and male. Among the second operation cases, the locations of the adjacent segments were the thoracolumbar junctional area and lumbosacral area in 11.6% and 88.4% of cases, respectively. Sagittal alignment was negative or neutral, positive and strongly positive in 47.3%, 38.9%, and 15.7%, respectively. Regarding the type of degeneration, spondylolisthesis or kyphosis, retrolisthesis, and neutral balance in the sagittal view was noted in 13.4%, 36.6%, and 50% of cases, respectively. There was a significant difference according to the location of the adjacent segment (p = 0.000) and sagittal alignment (p = 0.041).ConclusionsThe survival function of the adjacent segments was 94% at 10 years, which had decreased linearly by 0.6% per a year. The likelihood of a second operation was high in those with old age, degenerative disease, multiple-level fusion and male. There was a tendency for the type of degeneration to be spondylolisthesis or kyphosis in cases of the thoracolumbar junctional area and strongly positive sagittal alignment, but retrolisthesis in cases of the lumbosacral area and neutral or positive sagittal alignment.

Symptomatic adjacent segment degeneration at the L3–4 level after fusion surgery at the L4–5 level: evaluation of the risk factors and 10-year incidence

“…Although some previous clinical studies have reported that older patients are at a significantly higher risk of developing ASD after lumbar fusion surgery, some clinicians still believe that there is no correlation between age and ASD [25][26][27][28][29]. Our present results suggest that old age significantly elevates the hazard ratio for this condition.…”

“…Because we only evaluated fusion surgery cases at 1-2 spinal levels (L4-5 and L4-S1) as the index surgery, the proportion of our patients who developed CASD was most likely less than expected. Nonetheless, an earlier study by Ahn et al [26] reported 97 and 94 % disease-free survival rates in their patient cohort at 5 and 10 years, respectively. We believe that the inclusion of additional cases and a longer observation period would probably elevate our 10 year disease-free survival rate; that is, the percentage of patients who were followed over the 10 year observation period was probably too small to accurately assess the 10 year disease-free survival rate.…”

Clinical, radiological, histological and retrieval findings of Activ-L and Mobidisc total disc replacements: a study of two patients

“…Facet joint degeneration can contribute to recurrent back pain after TDR [10,[33][34][35]. The patient in case 1 had an anterior spinal fusion at L5-S1, which can accelerate facet joint degeneration, as well as unnatural motions in the L4-L5 Activ-L TDR [36][37][38]. In case 2, the patient received a two-level TDR which can lead to hypermobility and accelerates facet joint degeneration [39][40][41].…”

Chronic Opioid Therapy After Lumbar Fusion Surgery for Degenerative Disc Disease in a Workers’ Compensation Setting

“…7,9 Furthermore, lumbar fusion surgery for degenerative disc disease (DDD) and discogenic LBP also referred to as discogenic fusion, has been associated with variable clinical outcomes, particularly when compared with fusion for more definable instability, such as spondylolisthesis. [10][11][12][13][14][15][16][17][18] Some RCTs have reported significant improvement in Oswestry Disability Index (ODI) after discogenic fusion, but upon pooling data in a meta-analysis, Bydon et al recently reported no significant difference compared with nonoperative therapy. 18 DDD and discogenic LBP are estimated to now be the most common indications for lumbar fusion in the United States, as rates of discogenic fusion have increased approximately 220% since 1990.…”