J Korean Soc Spine Surg.  2008 Mar;15(1):44-53. 10.4184/jkss.2008.15.1.44.

Risk Factors for Adjacent Segment Disease After Lumbar Fusion

• Hwang C
• Lee SW
• Ahn YJ
• Kim YT
• Lee DH

• KMID: 1482843
• DOI: http://doi.org/10.4184/jkss.2008.15.1.44

Abstract

STUDY DESIGN: Retrospective study of adjacent segment disease.
OBJECTIVES
To describe the incidence and clinical features of adjacent segment disease (ASD) after lumbar fusion and to determine its risk factors. SUMMARY OF LITERATURE REVIEW: The reported incidence of adjacent segment problems is variable, and little has been discussed about surgically treated cases. Risk factors also have not been precisely identified, especially based on structural changes seen on magnetic resonance imaging (MRI).
MATERIALS AND METHODS
We analyzed the records of 1,124 patients who underwent lumbar or lumbosacral instrumented fusions between August 1995 and March 2006 and had at least one year follow-up. Of these patients, 28 patients who needed secondary operations because of ASD were included in this study. The disease group was compared with an age-, sex-, fusion level-, and follow-up period-matched control group composed of the same number of patients, toward the purpose of analyzing six variables as risk factors.
RESULTS
The incidence of ASD requiring surgical treatment was 2.48%. The mean patient age was 58.4 years, which showed no statistically significant difference from that of the population in which ASD did not develop (57.0 years, p=0.429). Only 1 distal ASD occurred among 21 floating fusions. Facet degeneration was a significant risk factor (p<0.01) on logistic regression analysis.
CONCLUSION
Our study patients with ASD complained of severe symptoms with frequent neurological abnormalities. The incidence of distal ASD was much lower than that of proximal ASD. Pre-existing facet degeneration may confer a high risk of adjacent segment problems after lumbar fusion procedures.

Keyword

Adjacent segment; Degeneration; Lumbar fusion; Risk factor

MeSH Terms

Follow-Up Studies
Humans
Incidence
Logistic Models
Magnetic Resonance Imaging
Retrospective Studies
Risk Factors

Figure

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  Fig. 1. Imaging studies of case 1. She had degenerative spondylolisthesis at L4-5 (A, B and C). Initial radiographs and MRI demonstrate rotational deformity at L3-4, disc wedging at L2-3, and grade 4 disc degeneration at L2-3, L3-4 and L5-S1 (C). Facet degeneration was grade 2 at L2-3 (D) and grade 1 at L3-4 (E). PLIF was performed at L4-5. Adjacent segment disease developed at L2-3 and L3-4 after 33 months (F, G and H). Central spinal stenosis aggravated at L2-3 (J) and L3-4 (K). Facet joints were intact at L1-2 (I). Revision surgery was performed from L2 to L5. Note that L5-S1 segment does not show any deterioration of degeneration.

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