J Korean Soc Spine Surg.  2004 Dec;11(4):238-245.

Adjacent Segment Degeneration After Spinal Fusion In Lumbar Degenerative Disorders

• Jeon CH
• Chung NS
• Yang YM
• Kim NH
• Kim YC
• Kim KH

Abstract

STUDY DESIGN: A retrospective radiological assessment was conducted.
OBJECTIVES
An attempt to analyze the degenerative change of an intervertebral disc for adjacent segment degeneration in lumbar degenerative diseases. LITERATURE REVIEW SUMMARY: A review of the literature failed to uncover any documented study examining the quantitative analysis of the degenerative change of the intervertebral disc for adjacent segment degeneration.
METHODS
This study was based on 45 patients, treated operatively or conservatively at this hospital, between April 1995 and July 2004. 39 and 6 cases of operative and conservative treatments, respectively, were performed. In the 39 operative treatments, there were 34 cases of fusion and 5 of discectomy. Dynamic X-ray and MRI were performed at the initial evaluation, and again more than 2 years later. In the 34 fusion cases, the upper and lower adjacent segments of the fused level were studied, and in the 11 non-fusion cases (conservative treatment or discectomy), the L3-4, L4-5 and L5-S1 level were studied. The instability of the dynamic X-ray and Thompson grade changes of the disc on MRI were also evaluated. Statistical analysis was carried out using the Wilcoxon signed rank test.
RESULTS
Adjacent segment degeneration was found in 10 of the 34 cases (29.4%) on plain X-ray. The average Thompson grades of the 33 upper segment cases were 2.6 and 3.4 preoperatively and postoperatively (P=0.000), and for the 24 of the lower segment cases were 2.9and 3.2 (P=0.033), respectively. No statistical increase in the Thompson grade was found in the non-fusion group.
CONCLUSIONS
The adjacent discs of the fusion group showed statistically meaningful degeneration on MRI, but this was not correlated with adjacent segment degeneration on plain X-ray. Various anatomical and functional factors must be considered in the evaluation of adjacent segment disease.

Keyword

Lumbar spine; Adjacent disc degeneration; Intervertebral disc; MRI

MeSH Terms

Diskectomy
Humans
Intervertebral Disc
Magnetic Resonance Imaging
Retrospective Studies
Spinal Fusion*

Figure

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  Fig. 1. (A) A 53-year-old woman with isthmic spondylolisthesis L4. The disc signal of L3-4 and L5-S1 was Thmpson grade I. Anterior interbody fusion and posterior fixation was done. (B) 9 years later, there was no remarkable change of adjacent disc.

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  Fig. 2. (A) A 22-year-old man with mild bulging of L4-5 and Thompson grade was grade II. Conservative treatment was done. (B) 2 years later, L4-5 herniation was severed and disc signal has changed to grade IV.

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