The Changes of Adjacent Segments after Fusions (above 3-levels to L5) in Degenerative Lumbar Spinal Disorders.
10.4184/jkss.2002.9.4.305
- Author:
Whoan Jeang KIM
1
;
Jin Sup YEOM
;
Jong Won KANG
;
Kyou Hyeun KIM
;
Jae Uk OH
;
Won Sik CHOY
Author Information
1. Department of Orthopaedic Surgery, Eulji University, Daejeon, Korea. ortho@hananet.net
- Publication Type:Original Article
- Keywords:
Degenerative lumbar spinal disorders;
Fusions;
Adjacent segments
- MeSH:
Classification;
Follow-Up Studies;
Humans;
Intervertebral Disc Degeneration;
Magnetic Resonance Imaging;
Pathology;
Retrospective Studies;
Spine
- From:Journal of Korean Society of Spine Surgery
2002;9(4):305-312
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
STUDY DESIGN: A retrospective study. OBJECTIVE: To evaluate the usefulness of MRI grading of disc degeneration in determining whether L5-S1 fusion is necessary in degenerative lumbar spinal disorders. SUMMARY OF LITERATURE REVIEW: Changes in adjacent segments are not well understood, after floating fusion has been performed. MATERIALS AND METHODS: We reviewed 16 surgical cases of degenerative lumbar spinal disorders from July 1996 to February 2000 with an average follow-up of 41 months. Fusion was done in patients without instability, pathology and narrowing of L5-S1. We measured the disc degeneration of adjacent segments in preoperative MRIs using the Modified Pearce classification. In spine AP, lateral and flexion-extension radiographs, we measured disc height, angular motion and instability changes and correlated these with disc degeneration. RESULTS: Disc height changes decreased in the upper and lower adjacent segments and preoperative disc degeneration above grade IV, decreased more in lower adjacent segment. A statistical correlation was found between disc degeneration and disc height changes in the lower segment (P=0.046), but not in the upper segment (P=0.649). The angular-motion was unchanged in the upper and lower adjacent segments, and no statistical correlation was found between disc degeneration and angular-motion changes (P=0.819, 0.208). Postoperative instability was found in the upper adjacent segment in 2 patients, but no statistical cor-relation was found between disc degeneration and instability (P=0.083, P=1.000). CONCLUSION: L5-S1 might be saved when free of pathology, and when disc degeneration is below grade III and balanced sagit-tally. However, further study is needed because of the short-term follow up and low number of cases in this study.
