The Revision Operation Rate for Adjacent Segmental Degeneration by Survival Analysis in Mono-segment Lumbar Fusion.
10.4055/jkoa.2010.45.4.314
- Author:
Tae Hyung KIM
1
;
Jin Hyok KIM
;
Sung Soo KIM
;
Dong Ju LIM
;
Jung Il HAN
;
Tai Wan KIM
;
Se Il SUK
Author Information
1. Seoul Spine Institute, Inje University Sanggye Paik Hospital, Seoul, Korea. kjh1026@paik.ac.kr
- Publication Type:Original Article
- Keywords:
adjacent segmental degeneration;
mono-segment fusion;
survival rate;
revision operation;
lumbar spine
- MeSH:
Aged;
Body Mass Index;
Follow-Up Studies;
Humans;
Multivariate Analysis;
Retrospective Studies;
Risk Factors;
Smoke;
Smoking;
Spine;
Survival Analysis*;
Survival Rate;
Transplants
- From:The Journal of the Korean Orthopaedic Association
2010;45(4):314-320
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To analyze survival rates of patients after mono-segmental lumbar or lumbosacral fusion and to evaluate factors affecting the revision operation due to adjacent segmental degeneration. MATERIALS AND METHODS: This study enrolled 1,206 patients who had mono-segmental lumbar or lumbosacral fusion between March 1997 and December 2006 at the Seoul Spine Institute. The survival rates for the revision operation due to adjacent segmental degeneration were analyzed retrospectively. The age at index operation, sex, etiologic diagnosis, fusion method, fusion level, substance of bone graft, operator, body mass index (BMI), and smoking were considered as risk factors for the revision operation. RESULTS: There were 27 patients with a revision operation for adjacent segmental degeneration (2.24%). The average follow-up period was 39.0 months (6 months to 12 years 6 months) and the average age at operation was 47.0 years (13 to 85 years). The survival rate at 5 years was 97.3%, and at 10 years it was 89.4%. Patients less than 50 years old had a significantly lower revision operation rate than those aged 50 or more (p=0.002). When fusion between the 4th lumbar and the 5th lumbar spinal vertebrae was done, the revision operation rate was significantly higher than for other levels (p=0.003). Obese patients with BMI> or =25 had a significantly higher revision rate than did patients with BMI<25 (p=0.040). In a comparison of circumferential fusion versus other types of fusion, circumferential fusion had a lower revision rate and the difference was significant (p=0.021). Other factors such as diagnosis, sex, surgeon, substance used for the bone graft, and smoking were not significant for revision rate (ps>0.05). In multivariate analysis, age alone was a significant risk factor (p=0.048, Hazard ratio=2.50). CONCLUSION: The most important factor for survival without revision surgery for adjacent segmental degeneration following instrumented mono-segment lumbar or lumbosacral fusion is the age at index operation. Patients 50 year-old or older should be informed of the possibility of adjacent segmental disease after instrumented mono-segment lumbar or lumbosacral fusion.
