J Korean Soc Spine Surg.  2002 Dec;9(4):332-340. 10.4184/jkss.2002.9.4.332.

Surgery for Adjacent Segment Changes after Lumbosacral Fusion

• Ha KY
• Kim YH
• Kang KS

• KMID: 2209715
• DOI: http://doi.org/10.4184/jkss.2002.9.4.332

Abstract

PURPOSE: To report upon surgical outcome in terms of adjacent segment changes after lumbosacral fusion and to analyze for risk factors indicating early surgical intervention for adjacent segment changes. MATERIAL AND METHODS: This was a retrospective study of twenty patients who underwent revision surgery for adjacent segment changes after lumbosacral fusion. Inclusion criteria were as follows: 1) minimum 24 months follow-up, 2) confirmed adjacent segment changes by CT-myelogram or MRI, 3) conservative treatment for at least 3months, 4) available preoperative X-ray films and 5) posterolateral fusions at a prior fusion. Correlation analysis was performed for age, sex, the number of fused levels, grade of radiographic degeneration and instrumentation using the independent sample t-Test.
RESULTS
Age, sex, the number of fused levels, the use of instrumentation and the preservation of lumbar lordosis were not correlated with the interval to revision (IR). However, the grade of radiographic degeneration (plain film and CT) were highly correlated with IR (R= -0.699, -0.654). Degenerative scoliosis had a shorter IR, with statistical significance (P<0.05), than other disease examined. Excellent and good clinical results were obtained in 14 patients (60%), and solid bony fusion was achieved in 18 patients (90%).
CONCLUSIONS
When deciding upon fusion level, especially in cases of degenerative scoliosis, the need for caution could not be overemphasized. The grade of radiographic degeneration provides a useful indicator for predicting earlier adjacent segment changes.

Keyword

Adjacent segment; Degeneration; Lumbosacral fusion

MeSH Terms

Animals
Follow-Up Studies
Humans
Lordosis
Magnetic Resonance Imaging
Retrospective Studies
Risk Factors
Scoliosis
X-Ray Film

Figure

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  Fig. 1. A 50-year-old female's radiographs (Case #3). (A) Immediate postoperative radiographs shows Kellgren grade III degeneration at L2, 3 level with L3-5 fusion for degenerative spondylolisthesis. (B) At postoperative 8 years, complete block at the adjacent segment is noted on myelogram. (C) For the adjacent segment stenosis, revision surgery was done with L1-3 fusion.

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  Fig. 2. A 62-year-old male's radiographs (Case #9). (A, B) Decompression and posterolateral fusion including L3-5 was done and then (C) revision fusion was done for adjacent segment stenosis after 5 years later. Solid fusion on the L3-5 area and revision fusion with pedicular screw on L1-3 was noted. One year later, he revisited with the complaint of severe low back pain with no history of injury. (D) Computed tomographic scan demonstrates the bilateral pedicle fracture involving L4 and then marginal sclerosis and irregularity of the fracture line suggests it as a stress fracture.

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  Fig. 3. A 63-year-old female's radiographs (Case #10). (A) Initial radiographs shows degenerative lumbar scoliosis and multiple disc wedging, but L2, 3 disc space is relatively preserved. (B) Kellgren grade III degeneration is noted at L2, 3 level on immediate postoperative radiographs. (C) At postoperative 6 years, severe disc collapsing is noted. (D) Extended fusion to L1 was done. Clinically she complains of frequent back pain without neurological symptoms.

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