Korean J Spine.  2010 Sep;7(3):143-149.

Radiologic Adjacent Segment Degeneration and Clinical Outcome after Two Level Fusion (L3-4-5 and L4-5-S1) in Degenerative Lumbar Spinal Disease

• Son S
• Kim DY
• Lee SG
• Kim WK
• Park CW
• Jun DS

Abstract

OBJECTIVE
We retrospectively analyzed correlation of the development of radiologic adjacent segment degeneration (ASD), clinical outcome, and the vertebral level of fusion in two-level posterior lumbar fusion cases. Furthermore, risk factors of ASD were investigated.
METHODS
From 2000 to 2007, a total of 50 patients were evaluated. Their mean age was 55.0 years and mean follow-up period was 52.7 months. The patients were divided into two groups according to the vertebral level of the fused segment. Group I included 35 patients with L3-4-5 fusion, while 15 patients with L4-5-S1 fusion were categorized into group II. The patients were also divided into two groups, according to the development of ASD. Odom's criteria was used to study clinical outcome, and Cobb's angle was used to evaluate radiologic outcome
RESULTS
Of 50 patients, radiologic ASD was found in 24 (48.0%) patients. Group I showed 16 (45.7%) patients with ASD, while Group II showed 8 (53.3%) patients with ASD, and they did not show a significant difference in development of ASD and clinical outcome. Clinical outcome of patients with ASD and the ones without ASD did not show significant difference. Meanwhile, patients with ASD were older and showed decrease of the lordotic angle, as well as significant hypermobility in the cranial adjacent segment, during follow-up.
CONCLUSION
Different vertebral regions of fusion in two-level posterior lumbar fusion did not show significant difference in development of radiologic ASD and clinical outcome. In the development of ASD, decrease of the lordotic angle, hypermobility in the cranial adjacent segment and age were significant factors.

Keyword

Spinal fusion; Postoperative complication; Lumbar vertebrae; Sacrum

MeSH Terms

Follow-Up Studies
Humans
Lumbar Vertebrae
Postoperative Complications
Retrospective Studies
Risk Factors
Sacrum
Spinal Diseases
Spinal Fusion