Posterior Lumbar Interbody Fusion in Degenerative Lumbar Spine Disease and Risk of Adjacent Segment Disease
Objective: To determine the chances of adjacent segment disease (ASD) and risk factors after posterior lumbar interbody fusion (PLIF).
Material and Methods: 110 patients of both genders with degenerative lumbar instability at L4/5 level were included in my study. We did PLIF in all our patients and followed our patients for one year. The following parameters were measured: the degree of lumbar lordosis, the degree lumbosacral angle, the disc space height and their dynamic angulation and the displacement of L3 over L4. We checked the outcome with the help of the Japanese orthopedic association (JOA) and Oswestry disability index (ODI). We divided the patients into groups A and B; group A includes patients with progression of degeneration at the proximal level (L3-L4), while group B with no progression of disease at proximal level.
Results: The 86 patients (78.18%) were in group A, and 24 patients (21.88%) were in group B. There were no significant difference in radiological parameters of both groups; lumbosacral angle of lordosis, L3 laminar inclination angle, preoperative degenerative changes at proximal level, L4–L5 lordosis and BMD before surgery. The clinically and statistically significant differenceswere of the age of the patients falling in two groups. We found that at the completion of study ODI and JOA were not significantly different in both groups (P >0.05).
Conclusion: Degenerative lumbar disease is an age related disease with no significant effect of radiological degenerations on the final outcome of our patients.No other possible risk factor has a significant effect on outcome.
2. Quinnell RC, Stockdale HR. Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Spine (Phila Pa 1976). 1981; 6: 263–267.
3. Okuda, S, Iwasaki, M, Miyauchi, A, Aono, H, Morita, M, Yamamoto, T. Risk factors for adjacent segment degeneration after PLIF. Spine (Phila Pa 1976). 2004; 29: 1535–1540.
4. Maragkos GA, Atesok K, Papavassiliou E. Prognostic factors for adjacent segment disease after L4-L5 lumbar fusion. Neurosurgery. Published Online, 2019.
5. Battie MG, Videman T, Parent E. Lumbar disc degeneration: epidemiology and genetics influences. Spine, 2004; 29: 2679–2690.
6. Liao JC, Chen WJ, Chen LH, Niu CC, Keorochana G. Surgical outcomes of degenerative spondylolisthesis with L5 – S1 disc degeneration: comparison between lumbar floating fusion and lumbosacral fusion at a minimum 5-year follow-up. Spine, 2011; 36 (19): 1600-1607.
7. Lee JC, Kim Y, Soh JW, Shin BJ. Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion: comparison of posterior lumber interbody fusion and posteriorlateral fusion. Spine, 2014; 39 (5): E339-E345.
8. Lad SP, Babu R, Baker AA, Ugiliweneza B, Kong M, Bagley CA, et al. Complications, reoperation rates, and health-care cost following surgical treatment of lumbar spondylolisthesis. J Bone Joint Surg Am. 2013; 6 (95): e162.
9. Bono CM, Lee CK. Critical analysis of trends in fusion for degenerative disc disease over the past 20 years: influence of technique on fusion rate and clinical outcome. Spine (Phila Pa 1976). 2004; 29 (4): 455–463; Discussion Z455.
10. Ghiselli G, Wang JC, Hsu WK, et al. L5–S1 segment survivorship and clinical outcome analysis after L4–L5 isolated fusion. Spine, 2003; 28: 1275–1280.
11. Forsth P, Michaelsson K, Sanden B. Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis? A two-year follow-up study involving 5390 patients. Bone Joint J. 2013; 95-B (7): 960–965.
12. Kettler A, Rohlmann F, Ring C, Mack C, Wilke HJ. Do early stages of lumbar intervertebral disc degeneration really cause instability? Evaluation of an in vitro database. Eur Spine J. 2011; 20 (4): 578–584.
13. Weinhoffer SL, Guyer RD, Herbert M, Griffith SL. Intradiscal pressure measurements above an instrumented fusion. A cadaveric study. Spine (Phila Pa 1976). 1995; 20 (5): 526–531. Doi: 10.1097/00007632-199503010-00004.
14. Sim HB, Murovic JA, Cho BY, Lim TJ, Park J. Biomechanical comparison of single-level posterior versus transforaminal lumbar interbody fusions with bilateral pedicle screw fixation: segmental stability and the effects on adjacent motion segments. J Neurosurg Spine, 2010; 12 (6): 700–708.
15. Berven S, Wadhwa R. Sagittal alignment of the lumbar spine. Neurosurg Clin N Am. 2018; 29 (3): 331–339. Doi: 10.1016/j.nec.2018.03.009.
16. Tsuji T, Watanabe K, Hosogane N, et al. Risk factors of radiological adjacent disc degeneration with lumbar interbody fusion for degenerative spondylolisthesis. J Orthop Sci. 2016; 21 (2): 133–137.
17. Kim H, Kang K, Chun H, Lee C, Chang B, Yeom JS. The influence of intrinsic disc degeneration of the adjacent segments on its stress distribution after one-level lumbar fusion. Eur Spine J. 2015; 24 (4): 827–837. Doi: 10.1007/s00586-014-3462-0.
18. Wang H, Ma L, Yang D, et al. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders. Medicine, 2017; 96 (5): e6032. Doi: 10.1097/MD.0000000000006032.
19. Anandjiwala J, Seo JY, Ha KY, et al. Adjacent segment degeneration after instrumented posterolateral lumbar fusion: a prospective cohort study with a minimum five-year follow-up. Eur Spine J. 2011; 20: 1951–60.
20. Liang B, Zhao J, Li N, et al. Surgical treatment of discogenic low back pain by minimally invasive transforaminal lumbar interbody fusion combined with unilateral pedicle screw fixation. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012; 26: 272–6.
21. Maruenda JI, Barrios C, Garibo F, et al. Adjacent segment degeneration and revision surgery after circumferential lumbar fusion: outcomes throughout 15 years of follow-up. Eur Spine J. 2016; 25: 1550–7.
22. Anandjiwala J, Seo JY, Ha KY, et al. Adjacent segment degeneration after instrumented posterolateral lumbar fusion: a prospective cohort study with a minimum five-year follow-up. Eur Spine J. 2011; 20: 1951–60.
23. Ruberte LM, Natarajan RN, Andersson GB. Influence of single-level degenerative lumbar e disc disease on the behavior of the adjacent segments—a finite element model study. J Biomech. 2009; 42: 341–8.
24. Liang J, Dong Y, Zhao H. Risk factors for predicting symptomatic adjacent segment degeneration requiring surgery in patients after posterior lumbar fusion. J Orthop Surg Res. 2014; 9: 97.
25. World Health Organisation. Obesity: Preventing and Managing the Global Epidemic. Geneva: World Health Organisation, 1997.
26. Guigui P, Lambert P, Lassale B, De- burge A. Long term outcome at adjacent levels of lumbar arthrodesis. Rev Chir Orthop Reparatrice Appar Mot. 1997; 83: 685–696.
Copyright (c) 2020 Pakistan Journal Of Neurological Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.