Adjacent Segment Disease Lumbar/Thoracolumbar Fusion: Minimum 5-Year Follow-Up

[Slackwater]

PMID: 17873819
Spine. 2007 Sep 15;32(20):2253-7

Adjacent Segment Disease Following Lumbar/Thoracolumbar Fusion With Pedicle Screw Instrumentation:

A Minimum 5-Year Follow-up

Cheh G, Bridwell KH, Lenke LG, Buchowski JM, Daubs MD, Kim Y, Baldus C.
Department of Orthopaedic Surgery, Wooridul Spine Hospital, Seoul, Korea.


Study Design
Retrospective radiographic outcomes analysis.

Objective
We had 3 hypotheses: 1) a longer fusion; 2) a more proximal instrumented vertebra, and 3) circumferential fusion versus posterior-only fusion would increase the likelihood of adjacent segment disease (ASD).

Summary of Background Data
The literature analyzing risk factors, prevalence, and presentation of patients with ASD is varied and without clear consensus.

Methods
A total of 188 patients with minimum 5-year follow-up who had lumbar/thoracolumbar fusion with pedicle screw instrumentation for degenerative disorders were included.

Radiographic ASD was defined by:<UL TYPE=SQUARE>1) development of spondylolisthesis >4 mm,
2) segmental kyphosis >10[degrees],
3) complete collapse of disc space, or
4) more than 2 grades worsening of Weiner classification.[/list]Clinical ASD was defined as <UL TYPE=SQUARE>1) symptomatic spinal stenosis,
2) intractable back pain, or
3) subsequent sagittal or coronal imbalance.[/list]Results
Radiographic ASD occurred in 42.6% (80 of 188) of patients. Patients with radiographic ASD had worse Oswestry scores (20.3 vs. 12.5; P = 0.001) at ultimate follow-up than those without ASD. Clinical ASD developed in 30.3% (57 of 188) of patients. Clinical ASD manifested as spinal stenosis (n = 47), instability-type back pain (n = 5), and sagittal or coronal imbalance (n = 5).

Age at surgery over 50 years and length of fusion were significant risk factors for the development of ASD in the lumbar spine. Fusion to L1-L3 proximally increased the risk of ASD when compared with L4 and L5. Circumferential fusion versus posterior fusion was not a significant factor in the development of ASD.

Conclusion
Patients over the age of 50 were at higher risk of developing clinical ASD than those 50 years old or younger. Length of fusion was a significant risk factor in the development of ASD in the lumbar spine. Fusion up to L1-L3 increased the risk of ASD when compared with L4 and L5. Circumferential fusion, as opposed to posterolateral fusion, was not a statistically significant risk factor for the development of ASD.

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Above abstract is on pubmed.gov. I do not have the full print out. I suggest correlation with Revision Surgery is of interest, but it appears the article may not cover that issue. However, the above data may align with Drs. Mirza and Deyo on Fusion Revision Surgery of 20% at 11 years.

Slackwater
mva: 2-level lumbar surgical candidate, age > 50