J Korean Orthop Assoc.  2011 Jun;46(3):205-211. 10.4055/jkoa.2011.46.3.205.

Revision Surgery for Spinal Stenosis Developed at the Adjacent Segment after Lumbar Fusion

• Cho KJ
• Park SR
• Jung JH
• Park JH

• KMID: 2185448
• DOI: http://doi.org/10.4055/jkoa.2011.46.3.205

Abstract

PURPOSE
To determine the factors influencing clinical results of revision surgery for spinal stenosis developed at the adjacent segment after spinal fusion.
MATERIALS AND METHODS
Nineteen patients underwent revision surgery by adjacent segment disease after decompression and posterolateral fusion with pedicle screw instrumentation for spinal stenosis. The control group was matched in terms of age, sex, and number of fused segment, posterior interbody fusion.
RESULTS
Oswestry disability index (ODI) was changed from 32.1 before surgery to 28.0 at the final follow up in the revision group. Compared to the improvement from 27.6 to 15.2 in the control group, there was a significant difference between both groups (p=0.002). Revision group had 1 nonunion and 2 proximal screw loosening. There was no late complication in the control group. In the revision group, 12 of 19 patients had disc degeneration before surgery at the upper lumbar segments which was not included in the fusion. They had an average 2.0 ODI improvement after revision surgery. On the other hand, 7 patients who had no degeneration at the unfused segment showed 7.4 ODI improvement.
CONCLUSION
The clinical result of revision surgery for spinal stenosis at the adjacent segment after spinal fusion was less satisfactory than the primary surgery. The contributing factors were late complications and preoperative disc degeneration at the segments which was not included in the fusion.

Keyword

adjacent segment disease; spinal stenosis; revision surgery; clinical outcome; spinal fusion

MeSH Terms

Decompression
Follow-Up Studies
Hand
Humans
Intervertebral Disc Degeneration
Spinal Fusion
Spinal Stenosis

Figure

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  Figure 1 A 58-years-old woman underwent posterior fusion for spinal stenosis 5 years ago. Lateral radiograph shows disc space narrowing at L3-4 and L2-3.

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  Figure 2 Postoperative lateral radiograph shows extension of fusion to L3.

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  Figure 3 Preoperative sagittal MRI showed spinal stenosis at L3-4, which was treated by revision surgery. In addition, it showed disc degeneration at L1-2 and L2-3, which were not fused in the revision surgery. The axial images showed L1-2 and L3-4.

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