Risk Factors for Adjacent Segment Disease after Posterolateral Lumbar Fusion.
10.4184/jkss.2008.15.3.174
- Author:
Kyu Yeol LEE
1
;
Sung Keun SOHN
;
Myung Jin LEE
;
Lih WANG
Author Information
1. Department of Orthopaedic Surgery, College of Medicine, Dong-A University, Busan, Korea. gylee@dau.ac.kr
- Publication Type:Original Article
- Keywords:
Adjacent segment;
Lumbar fusion;
Treatment outcome;
Risk factor
- MeSH:
Animals;
Follow-Up Studies;
Humans;
Lordosis;
Reoperation;
Retrospective Studies;
Risk Factors;
Sacrum;
Scoliosis;
Treatment Outcome
- From:Journal of Korean Society of Spine Surgery
2008;15(3):174-182
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
STUDY DESIGN: This is a retrospective study. OBJECTIVE: We wanted to analyze the treatment outcome and the risk factors for adjacent segment disease after lumbar fusion. SUMMARY OF LITERATURE REVIEW: Biomechanical alterations likely play a primary role in causing adjacent segment disease. Radiographically apparent, asymptomatic adjacent segment disease is common after lumbar fusion, but this does not correlate with the functional outcomes. MATERIALS AND METHODS: We reviewed 544 patients who underwent lumbar fusion at a minimum of 5-year follow-up between March 1993 and August 2006. Risk factors analysis was performed for 48 of 544 patients with adjacent segment disease and who were needed a second operation, and the treatment outcomes were assessed for 46 patients with a minimum 1-year follow-up after the second operation. The average interval to the second operation was 4.5 years, and the average follow-up after the second operation was 34.5 months. The treatment outcome was assessed by using the modified Brodsky criteria and the reoperation rate was assessed in relation to several risk factors. RESULTS: Excellent and good operative results were obtained in 29 cases (63%) and bony fusion was achieved in 41 cases (89%). Of the risk factors we examined, multi-level fusion, a high grade of initial radiographic degeneration, the loss of physiologic lumbar lordosis and the involvement of degenerative scoliosis were associated with a high reoperation rate, with statistical significance. Age, gender, the initial diagnosis, the upper placement of the proximal screws and the extent to the sacrum were not correlated with the reoperation rate. CONCLUSION: The treatment outcome was relatively satisfactory; however, the factors influencing the treatment outcome of the second operation still need to be considered. The fusion level, the initial radiographic degeneration, the preservation of lumbar lordosis and the involvement of degenerative scoliosis are considered to be risk factors for the failure of lumbar fusion.
