J Korean Soc Spine Surg.  2008 Dec;15(4):230-235. 10.4184/jkss.2008.15.4.230.

The Causes of Revision Arthrodesis for the Degenerative Changes at the Adjacent Segment after Lumbosacral Fusion for Degenerative Lumbar Diseases

• Song KJ
• Choi BW
• Song JH
• Kim GH

• KMID: 2209625
• DOI: http://doi.org/10.4184/jkss.2008.15.4.230

Abstract

STUDY DESIGN: A Retrospective study
OBJECTIVES
To analyze the causes of revision arthrodesis for the degenerative changes at the adjacent segment after lumbosacral fusion for degenerative lumbar diseases. SUMMARY OF LITERATURE REVIEW: Revision arthrodesis is quite common. However, there is some controversy regarding the causes and risk factors.
MATERIALS AND METHODS
Twenty cases who had undergone revision arthrodesis after lumbosacral fusion were examined. Preexisting degenerative changes to the adjacent segment, location of the adjacent segment and extent of fusion, as well as changes in lumbar lordosis were observed in primary arthrodesis, and the relationship between the changes in the adjacent segment degeneration were analyzed in terms of the area of residence, activity level and living pattern of the patients.
RESULTS
Preexisting degenerative changes in the adjacent segment were observed in 14 cases and degenerative changes developed at the proximal junction in 19. Multiple segment fusion were performed in 13 cases during primary arthrodesis, 9 cases developed degenerative changes at the proximal junction. Fifteen cases with abnormal postoperative lumbar lordosis demonstrated adjacent segment degeneration. Sixteen cases living in the countryside and 15 cases with a history of severe physical labor after the primary operation showed degenerative changes in the adjacent segment before secondary arthrodesis.
CONCLUSION
The causes of revision arthrodesis for the degenerative changes at the adjacent segment are believed to be preexisting degenerative changes in the adjacent segment at the proximal junction, loss of lordosis after primary fusion, and severe physical labor from living in the countryside

Keyword

Lumbosacral fusion; Adjacent segment degeneration; Revision arthrodesis

MeSH Terms

Animals
Arthrodesis
Humans
Lordosis
Retrospective Studies

Reference

01). Cho JL., Park YS., Han JH., Lee CH., Rho WI. The changes of adjacent segments after spinal fusion, followup more than three years after spinal fusion. J Kor Soc Spine Surg. 1998. 5:239–246.

02). Etebar S., Cahill DW. Risk factors for adjacent segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg. 1999. 90:163–169.

03). Ha KY., Kim KW., Park SJ., Lee YH. Changes of the adjacent-unfused mobile segment after instrumental lumbar fusion, more than 5-years follow-up. J Kor Soc Spine Surg. 1998. 5:205–214.

04). Shono Y., Kaneda K., Abum K., McAfee PC., Cunningham BW. Stability of posterior spinal instrumentation and its effects on adjacent motion segments in the lumbosacral spine. Spine. 1998. 23:1550–1558.

05). Frymoyer JW., Hanley EN Jr., Howe J., Kuhlmann D., Matteri RE. A comparison of radiographic findings in fusion and non-fusion patients in or more years following lumbar disc surgery. Spine. 1979. 4:435–440.

06). Lee CK. Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine. 1988. 13:375–377.

07). Schlegel JD., Smith JA., Schleusener RL. Lumbar motion segment pathology adjacent to thoracolumbar, lumbar and lumbosacral fusions. Spine. 1996. 21:970–981.

08). Kellgren JH., Lawrence JS., Bler F. Genetic factors in generalized osteo-arthrosis. Ann Rheum Dis. 1963. 22:237–255.

09). Gelb DE., Lenke LG., Bridwell KH., Blanke K., McEnery KW. An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine. 1995. 20:1351–1358.

10). Aota Y., Kumano K., Hirabayashi S. Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J Spinal Disord. 1995. 8:464–473.

11). Hambly MF., Wiltse LL., Raghavan N., Schneiderman G., Koenig C. The transition zone above a lumbosacral fusion. Spine. 1998. 23:1785–1792.

12). Cunningham BW., Kotani Y., McNulty PS., Cappuccino A., McAfee PC. The effect of spinal destabilization and instrumentation on lumbar intradiscal pressure: an in vitro biomechanical analysis. Spine. 1997. 22:2655–2663.

13). Lee CK., Langrana NA. Lumbosacral spinal fusion: A biomechanical study. Spine. 1984. 9:574–581.

14). Weinhoffer SL., Guyer RD., Herbert M., Griffith SL. Intradiscal pressure measurements above an instrumented fusion: a cadaveric study. Spine. 1995. 20:526–531.

15). Pfirrmann CW., Metzdorf A., Zanetti M., Hodler J., Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine. 2001. 26:1873–1878.

16). Grouw AV., Nadel CI., Weierman RJ., Lowell HA. Long term follow-up of patients with idiopathic scoliosis treated surgically: A preliminary subjective study. Clin Orthop Relat Res. 1976. 117:197–201.

17). Goel VK., Voo LM., Weinstein JN., Liu YK., Okuma T., Njus GO. Response of the ligamentous lumbar spine to cyclic bending loads. Spine. 1998. 13:294–300.

18). Lehmann TR., Spratt KF., tozzi JE, et al. Long-term follow-up of lower lumbar fusion patients. Spine. 1987. 12:97–104.

19). Whitecloud TS 3rd., Davis JM., Olive PM. Operative treatment of the degenerated segment adjacent to a lumbar fusion. Spine. 1994. 19:531–536.