1.Does Percutaneous Lumbosacral Pedicle Screw Instrumentation Prevent Long-Term Adjacent Segment Disease after Lumbar Fusion?
Stuart CHANGOOR ; Michael Joseph FALOON ; Conor John DUNN ; Nikhil SAHAI ; Kimona ISSA ; Kumar SINHA ; Ki Soo HWANG ; Arash EMAMI
Asian Spine Journal 2021;15(3):301-307
Retrospective cohort study. To assess long-term clinical outcomes of adjacent segment disease (ASD) in patients who underwent lumbar interbody fusion with percutaneous pedicle screw (PS) instrumentation. ASD is a well-known sequela of spinal fusion, and is reported to occur at a rate of 2%–3% per year. There is debate as to whether ASD is a result of the instrumentation and fusion method or is the natural history of the patient’s disease. Minimally invasive percutaneous PS augmentation of lumbar interbody fusion aims to prevent the disruption of posterior soft tissue stabilizers. From 2004–2014, 419 consecutive patients underwent anterior, lateral, or minimally invasive transforaminal lumbar interbody fusion with percutaneous PS placement at a single institution. The mean follow-up was 4.5 years. The primary outcome measure was reoperation due to ASD. Patients were divided into two cohorts: those who underwent revision surgery secondary to ASD and those who did not require further surgery. Radiographic parameters were performed using postoperative radiographs. Patients with a pelvic incidence–lumbar lordosis (PI–LL) mismatch >10° were noted. Revision proportion secondary to ASD was 4.77% (n=20). Mean time to revision surgery was 2.5 years. Revision rate secondary to ASD was 1.1% per year. Patients who developed ASD were younger than those who did not (50.5 vs. 56.9 years, ASD rates in patients who underwent percutaneous PS placement were lower than those previously published after open PS placement, possibly related to greater preservation of the posterior stabilizing elements of the lumbar spine.
2.Does Percutaneous Lumbosacral Pedicle Screw Instrumentation Prevent Long-Term Adjacent Segment Disease after Lumbar Fusion?
Stuart CHANGOOR ; Michael Joseph FALOON ; Conor John DUNN ; Nikhil SAHAI ; Kimona ISSA ; Kumar SINHA ; Ki Soo HWANG ; Arash EMAMI
Asian Spine Journal 2021;15(3):301-307
Retrospective cohort study. To assess long-term clinical outcomes of adjacent segment disease (ASD) in patients who underwent lumbar interbody fusion with percutaneous pedicle screw (PS) instrumentation. ASD is a well-known sequela of spinal fusion, and is reported to occur at a rate of 2%–3% per year. There is debate as to whether ASD is a result of the instrumentation and fusion method or is the natural history of the patient’s disease. Minimally invasive percutaneous PS augmentation of lumbar interbody fusion aims to prevent the disruption of posterior soft tissue stabilizers. From 2004–2014, 419 consecutive patients underwent anterior, lateral, or minimally invasive transforaminal lumbar interbody fusion with percutaneous PS placement at a single institution. The mean follow-up was 4.5 years. The primary outcome measure was reoperation due to ASD. Patients were divided into two cohorts: those who underwent revision surgery secondary to ASD and those who did not require further surgery. Radiographic parameters were performed using postoperative radiographs. Patients with a pelvic incidence–lumbar lordosis (PI–LL) mismatch >10° were noted. Revision proportion secondary to ASD was 4.77% (n=20). Mean time to revision surgery was 2.5 years. Revision rate secondary to ASD was 1.1% per year. Patients who developed ASD were younger than those who did not (50.5 vs. 56.9 years, ASD rates in patients who underwent percutaneous PS placement were lower than those previously published after open PS placement, possibly related to greater preservation of the posterior stabilizing elements of the lumbar spine.