Risk Factors for Adjacent Segment Disease Development after Lumbar Fusion

Sergei Masevnin; Dmitry Ptashnikov; Dmitry Michaylov; Hao Meng; Oleg Smekalenkov; Nikita Zaborovskii

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자료유형: 학술저널

저자정보: Sergei Masevnin (Vreden Russian Research Institute of Traumatology and Orthopedics) Dmitry Ptashnikov (Vreden Russian Research Institute of Traumatology and Orthopedics) Dmitry Michaylov (Vreden Russian Research Institute of Traumatology and Orthopedics) Hao Meng (Vreden Russian Research Institute of Traumatology and Orthopedics) Oleg Smekalenkov (Vreden Russian Research Institute of Traumatology and Orthopedics) Nikita Zaborovskii (Vreden Russian Research Institute of Traumatology and Orthopedics)

저널정보: 대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.9 No.2

발행연도: 2015.4

수록면: 239 - 244 (6page)

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Study Design: Retrospective cohort study. Purpose: To identify factors which may be important in the occurrence of symptomatic adjacent segment disease (ASD) after lumbar fusion. Overview of Literature: Many reports have been published about the risk factors for ASD after lumbar fusion. Despite on the great numbers of risk factors identified for ASD development, study results have been inconsistent and there is controversy regarding which are the most important. Methods: This study evaluated 120 patients who underwent 360° fusion lumbar surgery from 2007 to 2012. We separated the population into two groups: the first group included 60 patients with long lumbar fusion (three or more levels) and the second group included 60 patients with short lumbar fusion (less than three levels). Results: In the first group, symptomatic ASD was found in 19 cases during the one year follow-up. There were 14 cases with sagittal imbalance and 5 cases at the incipient stage of disc degeneration according to the preoperative magnetic resonance imaging. At the three year follow-up, symptomatic ASD was diagnosed in 31 cases, of which 17 patients had postoperative sagittal balance disturbance. In the second group, 10 patients had ASD at the one year follow-up. Among these cases, preoperative disc degenerative changes were identified in 8 patients. Sagittal imbalance was found only in 2 cases with symptomatic ASD at the one year followup. At the three year follow-up, the number of patients with symptomatic ASD increased to 14. Among them, 13 patients had initial preoperative adjacent disc degenerative changes. Conclusions: Patients with postoperative sagittal imbalance have a statistically significant increased risk of developing symptomatic ASD due to an overloading the adjacent segments and limited compensatory capacities due to the large number of fixed mobile segments. In the case of a short fixation, preoperative degenerative changes are more important factors in the development of ASD.

#Fusion #Adjacent segment disease #Sagittal balance

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