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Daniels AH, Balmaceno-Criss M, McDonald CL, Singh M, Knebel A, Kuharski MJ, Daher M, Alsoof D, Lafage R, Lafage V, Diebo BG. Segmental Sagittal Alignment in Lumbar Spinal Fusion: A Review of Evidence-Based Evaluation of Preoperative Measurement, Surgical Planning, Intraoperative Execution, and Postoperative Evaluation. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01153. [PMID: 38690883 DOI: 10.1227/ons.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/05/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Maintaining and restoring global and regional sagittal alignment is a well-established priority that improves patient outcomes in patients with adult spinal deformity. However, the benefit of restoring segmental (level-by-level) alignment in lumbar fusion for degenerative conditions is not widely agreed on. The purpose of this review was to summarize intraoperative techniques to achieve segmental fixation and the impact of segmental lordosis on patient-reported and surgical outcomes. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, PubMed, Embase, Cochrane, and Web of Science databases were queried for the literature reporting lumbar alignment for degenerative lumbar spinal pathology. Reports were assessed for data regarding the impact of intraoperative surgical factors on postoperative segmental sagittal alignment and patient-reported outcome measures. Included studies were further categorized into groups related to patient positioning, fusion and fixation, and interbody device (technique, material, angle, and augmentation). RESULTS A total of 885 studies were screened, of which 43 met inclusion criteria examining segmental rather than regional or global alignment. Of these, 3 examined patient positioning, 8 examined fusion and fixation, 3 examined case parameters, 26 examined or compared different interbody fusion techniques, 5 examined postoperative patient-reported outcomes, and 3 examined the occurrence of adjacent segment disease. The data support a link between segmental alignment and patient positioning, surgical technique, and adjacent segment disease but have insufficient evidence to support a relationship with patient-reported outcomes, cage subsidence, or pseudoarthrosis. CONCLUSION This review explores segmental correction's impact on short-segment lumbar fusion outcomes, finding the extent of correction to depend on patient positioning and choice of interbody cage. Notably, inadequate restoration of lumbar lordosis is associated with adjacent segment degeneration. Nevertheless, conclusive evidence linking segmental alignment to patient-reported outcomes, cage subsidence, or pseudoarthrosis remains limited, underscoring the need for future research.
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Affiliation(s)
- Alan H Daniels
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Christopher L McDonald
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Manjot Singh
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Ashley Knebel
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Michael J Kuharski
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Mohammad Daher
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Daniel Alsoof
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Renaud Lafage
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, New York, USA
| | - Virginie Lafage
- Department of Orthopedic Surgery, Lenox Hill Northwell, New York, New York, USA
| | - Bassel G Diebo
- Department of Orthopedics Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
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Cannizzaro D, Anania CD, Safa A, Zaed I, Morenghi M, Riva M, Tomei M, Pessina F, Servadei F, Ortolina A, Fornari M. Lumbar adjacent segment degeneration after spinal fusion surgery: a systematic review and meta-analysis. J Neurosurg Sci 2023; 67:740-749. [PMID: 36345970 DOI: 10.23736/s0390-5616.22.05891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
INTRODUCTION Adjacent segment degeneration is among the most recognized long-term complications of lumbar surgery for degenerative spine pathologies with a relevant impact in spine surgical and clinical practice. It is reported a incidence of clinical adjacent segment disease between 5-30% of patients undergoing spinal fusion. We aimed to evaluate the main clinical and surgical risk factors for developing adjacent segment disease. EVIDENCE ACQUISITION A systematic review and meta-analysis of the pertinent literature was performed, according to PRISMA and PICO guidelines, focusing on clinical and radiological adjacent segment disease. We exclusively included studies reporting demographic and clinical data, and surgical details published from 30 September 2015 to 30 September 2020. The effect of considered risk factors on the presence of adjacent segment disease was explored with a random-effects model. EVIDENCE SYNTHESIS A total of 15 scientific publications, corresponding to 6253 patients, met the inclusion criteria for the qualitative and quantitative analysis. 720 of the patients developed a clinical and/or radiological adjacent syndrome disease, and 473 have been surgically managed. Ten articles qualified for the comparative geographical analysis. Advanced age and obesity are relevant risk factors for developing lumbar adjacent segment degeneration. Our data also reported a higher prevalence of adjacent segment degeneration in Western populations than in Eastern populations. The interbody fusion has a protective role toward lumbar adjacent segment degeneration. CONCLUSIONS This study highlighted multifactorial issues regarding adjacent segment disease: clinical, anatomical, biomechanical, and radiological features. In view of increasing life expectancy and spinal surgery procedures, extensive multicenter studies will be needed to define the correct management of the adjacent segment disease.
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Affiliation(s)
- Delia Cannizzaro
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy -
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy -
| | - Carla D Anania
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Adrian Safa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Ismail Zaed
- Department of Neurosurgery, Neurocenter of South Switzerland, Ente Ospedaliero Cantonale Lugano, Bellinzona, Switzerland
| | - Manuela Morenghi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco Riva
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Massimo Tomei
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Franco Servadei
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Takeda K, Okada E, Shinozaki Y, Ozaki M, Kono H, Yasuda A, Suzuki S, Tsuji O, Nagoshi N, Yagi M, Fujita N, Ogawa J, Nakamura M, Matsumoto M, Watanabe K. Risk factors for early-onset radiographical adjacent segment disease in patients with spondylolytic spondylolisthesis after single-level posterior lumbar interbody fusion. Spine J 2022; 22:1112-1118. [PMID: 35158045 DOI: 10.1016/j.spinee.2022.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The risk factors for radiographical adjacent segment disease (ASD) in patients with degenerative spondylolisthesis have been previously reported. However, there are only few reports on patients with spondylolytic spondylolisthesis who underwent single-level posterior lumbar interbody fusion (PLIF). PURPOSE The study aimed to investigate the risk factors for radiographical ASD in patients with L5-S1 spondylolytic spondylolisthesis who underwent single-level PLIF. STUDY DESIGN/SETTING A retrospective study PATIENT SAMPLE: This study retrospectively reviewed 135 consecutive patients (91 men and 44 women) with symptomatic L5-S1 spondylolytic spondylolisthesis who underwent single-level PLIF. OUTCOME MEASURES The pre- and postoperative (at the final follow-up) spinopelvic parameters, % slip, sacral slope, lumbar lordosis (LL), pelvic tilt, pelvic incidence (PI), PI minus LL (PI - LL), lumbosacral angle, C7 sagittal vertical axis, and thoracic kyphosis were measured using standing radiographs. METHODS Radiographical ASD was defined as disc height loss (>3 mm), increase of posterior angulation (>5°), or progression of spondylolisthesis (>3 mm) between the pre- and postoperative radiographs. Pfirrmann's classification was used to evaluate disc degeneration. The radiographical parameters and changes between the pre- and postoperative values were evaluated and compared for the non-ASD and ASD groups. Binary logistic regression analysis was performed to evaluate the adjusted associations between each potential explanatory variable and ASD development. RESULTS The radiographical ASD incidence was 11%. Additionally, 60% of the patients with ASD had radiographical ASD at 1 year and all cases of radiographical ASD in this follow-up period occurred within 3 years after the initial surgery. The mean period of ASD occurrence after initial surgery was 21.7 ± 12.6 months. No patients required reoperation for radiographical ASD. Multivariate analysis revealed that a preoperative (odds ratio [OR], 5.9; 95% confidence interval [CI], 1.2-28.9; p=.03) and a postoperative (OR, 6.5; 95% CI, 1.2-34.5; p=.03) PI - LL of ≥15° were risk factors for radiographical ASD. CONCLUSIONS Pre- and postoperative PI - LL value mismatch was identified as significant independent risk factors for radiographical ASD in patients with L5-S1 spondylolytic spondylolisthesis. Obtaining larger lordosis at L5-S1 may be the key to preventing radiographical ASD.
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Affiliation(s)
- Kazuki Takeda
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Yoshio Shinozaki
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masahiro Ozaki
- Department of Orthopaedic Surgery, Medical Corporation Keiyukai Keiyu Orthopedic Hospital, Gunma, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Hitoshi Kono
- Department of Orthopaedic Surgery, Medical Corporation Keiyukai Keiyu Orthopedic Hospital, Gunma, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Akimasa Yasuda
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Fujita Health University, Toyoake, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Jun Ogawa
- Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan; Keio Spine Research Group (KSRG), Tokyo, Japan.
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Nakajima H, Honjoh K, Watanabe S, Kubota A, Matsumine A. Negative impact of short-level posterior lumbar interbody fusion in patients with diffuse idiopathic skeletal hyperostosis extending to the lumbar segment. J Neurosurg Spine 2021:1-7. [PMID: 34653984 DOI: 10.3171/2021.5.spine21412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/27/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The development of diffuse idiopathic skeletal hyperostosis (DISH) often requires further surgery after posterior decompression without fusion because of postoperative intervertebral instability. However, there is no information on whether fusion surgery is recommended for these patients as the standard surgery. The aim of this study was to review the clinical and imaging findings in lumbar spinal canal stenosis (LSS) patients with DISH affecting the lumbar segment (L-DISH) and to assess the indication for fusion surgery in patients with DISH. METHODS A total of 237 patients with LSS underwent 1- or 2-level posterior lumbar interbody fusion (PLIF) at the authors' hospital and had a minimum follow-up period of 2 years. Patients with L-DISH were classified as such (n = 27, 11.4%), whereas those without were classified as controls (non-L-DISH; n = 210, 88.6%). The success rates of short-level PLIF were compared in patients with and those without L-DISH. The rates of adjacent segment disease (ASD), pseudarthrosis, postoperative symptoms, and revision surgery were examined in the two groups. RESULTS L-DISH from L2 to L4 correlated significantly with early-onset ASD, pseudarthrosis, and the appearance of postsurgical symptoms, especially at a lower segment and one distance from the segment adjacent to L-DISH, which were associated with the worst clinical outcome. Significantly higher percentages of L-DISH patients developed ASD and pseudarthrosis than those in the non-L-DISH group (40.7% vs 4.8% and 29.6% vs 2.4%, respectively). Of those patients with ASD and/or pseudarthrosis, 69.2% were symptomatic and 11.1% underwent revision surgery. CONCLUSIONS The results highlighted the negative impact of short-level PLIF surgery for patients with L-DISH. Increased mechanical stress below the fused segment was considered the reason for the poor clinical outcome.
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Choi SH, Son SM, Kang CN, Lee MK, Kook I, Lee JS. Reproducibility and Accuracy of Pelvic Tilt in Predicting the Difference Between Pelvic Incidence and Lumbar Lordosis Value. World Neurosurg 2021; 155:e621-e629. [PMID: 34482011 DOI: 10.1016/j.wneu.2021.08.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We investigated the pelvic morphologic factors that determine the degree of pelvic incidence (PI)-lumbar lordosis (LL) mismatch. METHODS Overall, 306 patients were included. The regional and global sagittal parameters were measured. Linear regression analyses were performed for 4 pelvic parameters and PI-LL mismatch. E1 and E2 were defined as linear regression equations between pelvic tilt (PT) and PI-LL mismatch and PI and PI-LL mismatch, respectively. The patients were categorized by cluster analysis using the hierarchal method for the 4 pelvic parameters. RESULTS E1 and E2 showed statistical significance; however, the coefficient of determination of E1 was higher than that of E2 (R2 = 0.675 vs. 0.238; P < 0.01). Sex, LL, E1, and E2 showed significant differences in the regional parameters. The T1 pelvic angle (TPA), spinosacral angle (SSA), and incidence angle of inflection points (IAIPs) showed significant differences in global parameters (P < 0.01). The IAIPs and TPA were low in the anteverted pelvis group and high in the retroverted pelvis group (P < 0.001). The SSA was low in the small pelvis group and high in the large pelvis group (P < 0.001). The proportion of women in the large pelvis group (93%) was significantly higher than that in the other groups (P < 0.01). CONCLUSIONS The individual differences between the PI and LL values can be more accurately determined using the individual PT, and the optimal PT amount will differ depending on the pelvis shape. The increase in the TPA and IAIPs corresponded to the PT, and the SSA increased in accordance with the pelvic size.
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Affiliation(s)
- Sung Hoon Choi
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seung Min Son
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University, Yangsan Hospital, Yangsan, Republic of Korea
| | - Chang-Nam Kang
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Myoung Keun Lee
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Incheol Kook
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, BioMedical Research Institute, Pusan National University Hospital, Pusan National University, Busan, Republic of Korea.
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Chang DG, Park JB, Kim HJ. Hyperacute onset of adjacent segment disease with dorsally migrated herniated nucleus pulposus causing cauda equina syndrome: a case report. Br J Neurosurg 2021:1-4. [PMID: 34474611 DOI: 10.1080/02688697.2021.1973368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 06/19/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To report the first case of hyperacute onset of adjacent segmental disease (ASD) with dorsally migrated herniated nucleus pulposus (HNP) causing cauda equina syndrome. METHODS A 55-year-old female complained of lower back pain with radiating pain in both lower extremities that had not responded to conservative treatment over the previous six months. Plain radiographs and magnetic resonance imaging (MRI) findings revealed degenerative spondylolisthesis with spinal stenosis at L3-4, L4-5, and a slight bulging disc at L2-3. The patient underwent decompressive total laminectomy and posterior fusion at L3-4 and L4-5. The stenotic symptoms improved significantly after surgery, and she was then discharged on postoperative day 7. RESULTS However, the patient visited the emergency department four days after discharge (postoperative day 11) complaining of sudden onset of bilateral lower extremity weakness and voiding and defecation difficulties. The follow-up MRI showed dorsally migrated huge HNP and a detached posterior longitudinal ligament (PLL) at L2-3, which was diagnosed as hyperacute onset of ASD causing cauda equina syndrome. The patient underwent an emergency second operation consisting of partial laminectomy at L2-3 with removal of the dorsally migrated huge HNP. After the second operation, the symptoms of cauda equina syndrome improved. One year after the second operation, the patient is doing well without recurrence of symptoms. CONCLUSIONS Our case showed that hyperacute onset of ASD with dorsally migrated huge HNP can cause cauda equina syndrome, even within 2 weeks after lumbar fusion surgery. Therefore, a high index of suspicion, timely diagnosis, and surgical treatment are needed to avoid the catastrophic neurologic complications in similar extremely rare cases.
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Affiliation(s)
- Dong-Gune Chang
- Department of Orthopaedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, Korea
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong Jin Kim
- Department of Orthopaedic Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Inje University, Seoul, Korea
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Cho HJ, Ko YS, Won YI, Lee CH, Yang SH, Kim CH, Chung CK. The Efficacy of Lumbar Hybrid Fusion for the Prevention of Adjacent Segment Disease: Fact or Artifact? A Meta-analysis. Clin Spine Surg 2021; 34:260-268. [PMID: 33044274 DOI: 10.1097/bsd.0000000000001097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A systematic literature review and meta-analysis. OBJECTIVE The aim of this study is to compare hybrid constructs with traditional fusion-only constructs for the incidence of adjacent segment degeneration (ASDeg) and clinical outcomes in patients with degenerative lumbar diseases. SUMMARY OF BACKGROUND DATA Spinal fusion is a standard surgery for various pathologies of the lumbar spine, which results in changes to the biomechanics of the spine, potentially leading to ASDeg. Although ASDeg can occur slowly as a natural course, early-onset ASDeg is regarded to be related to fusion surgery. MATERIALS AND METHODS A systematic search was conducted to identify studies that match the purpose. Included studies were compared using the incidence of ASDeg, Oswestry Disability Index, Visual Analog Score, and perioperative outcomes. We calculated the Peto odds ratio and mean difference (MD) for the continuous variables, respectively. In the hybrid group, subgroup analysis was also performed among devices. RESULTS Among 10 papers involving 767 patients, 372 patients underwent hybrid fusion and 395 patients underwent fusion-only. ASDeg occurred in 10.2% in the hybrid and 21.5% in the fusion-only group [Peto odds ratio, 0.39; 95% confidence interval (CI), 0.23-0.64]. The MD for Visual Analog Score were 0.45 (95% CI, 0.05-0.85) between 2 groups, which was statistically significant but was too small to have clinical significance. The MD for Oswestry Disability Index was 0.93 (95% CI, -1.016 to 2.872), which was not statistically different between 2 groups. The hybrid is superior for 18 minutes (95% CI, 5.78-30.72) shorter than typical surgery. CONCLUSIONS Hybrid lumbar surgery decreased the incidence of early-onset ASDeg for about 2 years of follow-up. Among the hybrid constructs, the interspinous devices group accomplished favorable results with a lower risk. Adjacent segment disease was not as statistically significant as ASDeg, but adjacent segment disease may show a substantial difference for >2-year follow-up.
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Affiliation(s)
- Hyun-Jae Cho
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Young San Ko
- Department of Neurosurgery, Seoul National University Hospital, Seoul
| | - Young Il Won
- Department of Neurosurgery, Seoul National University Hospital, Seoul
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul.,Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seongnam-si
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University Hospital, Seoul
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul.,Department of Neurosurgery, Seoul National University College of Medicine
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul.,Department of Neurosurgery, Seoul National University College of Medicine.,Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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Okuda S, Nagamoto Y, Takenaka S, Ikuta M, Matsumoto T, Takahashi Y, Furuya M, Iwasaki M. Effect of segmental lordosis on early-onset adjacent-segment disease after posterior lumbar interbody fusion. J Neurosurg Spine 2021; 35:454-459. [PMID: 34298517 DOI: 10.3171/2020.12.spine201888] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/11/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although several reports have described adjacent-segment disease (ASD) after posterior lumbar interbody fusion (PLIF), there have been only a few reports focusing on early-onset ASD occurring within 3 years after primary PLIF. The purpose of this study was to investigate the prevalence and postoperative pathologies of early-onset ASD and its relation with radiological parameters such as segmental lordosis (SL). METHODS The authors reviewed a total of 256 patients who underwent single-segment PLIF at L4-5 for degenerative lumbar spondylolisthesis (DLS) and were followed up for at least 5 years. The definition of ASD was a symptomatic condition requiring an additional operation at the adjacent fusion segment in patients who had undergone PLIF. ASD occurring within 3 years after primary PLIF was categorized as early-onset ASD. As a control group, 54 age- and sex-matched patients who had not suffered from ASD for more than 10 years were selected from this series. RESULTS There were 42 patients with ASD at the final follow-up. ASD prevalence rates at 3, 5, and 10 years postoperatively and at the final follow-up were 5.0%, 8.2%, 14.1%, and 16.4%, respectively. With respect to ASD pathologies, lumbar disc herniation (LDH) was significantly more common in early-onset ASD, while lumbar spinal stenosis and DLS occurred more frequently in late-onset ASD. Significant differences were detected in the overall postoperative range of motion (ROM) and in the changes in ROM (ΔROM) at L3-4 (the cranial adjacent fusion segment) and changes in SL (ΔSL) at L4-5 (the fused segment), while there were no significant differences in other pre- and postoperative parameters. In stepwise logistic regression analysis, ΔSL was identified as an independent variable (p = 0.008) that demonstrated significant differences, especially in early-onset ASD (control 1.1° vs overall ASD -2.4°, p = 0.002; control 1.1° vs early-onset ASD -6.6°, p = 0.00004). CONCLUSIONS The study results indicated that LDH was significantly more common as a pathology in early-onset ASD and that ΔSL was a major risk factor for ASD, especially early-onset ASD.
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Affiliation(s)
- Shinya Okuda
- 1Department of Orthopaedic Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka; and
| | - Yukitaka Nagamoto
- 1Department of Orthopaedic Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka; and
| | - Shota Takenaka
- 2Department of Orthopaedic Surgery, Osaka University Medical School, Suita, Osaka, Japan
| | - Masato Ikuta
- 1Department of Orthopaedic Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka; and
| | - Tomiya Matsumoto
- 1Department of Orthopaedic Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka; and
| | - Yoshifumi Takahashi
- 1Department of Orthopaedic Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka; and
| | - Masayuki Furuya
- 1Department of Orthopaedic Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka; and
| | - Motoki Iwasaki
- 1Department of Orthopaedic Surgery, Osaka Rosai Hospital, Kita-ku, Sakai, Osaka; and
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Knappe UJ, Reinecke D, Flörke M, Horn P, Schönmayr R. Facet Joint Replacement: Intermediate- and Long-Term Outcome in a Large Case Series. J Neurol Surg A Cent Eur Neurosurg 2020; 82:34-42. [PMID: 33278826 DOI: 10.1055/s-0040-1716534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The long-term outcome of facet joint replacement (FJR) still is to be proven. METHODS We present a prospective case series of 26 (male-to-female ratio of 1:1; mean age: 61 years) patients undergoing FJR with a follow-up of at least 1 year (range: 12-112; mean: 67 months). Visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and the 12-Item Short Form Health Survey (SF-12) were applied pre- and postoperatively (after 3, 6, and 12 months) as well as at the last follow-up (N = 24). Using X-rays of the lumbar spine (N = 20), the range of motion (ROM) and disk height in the indicator and adjacent levels were assessed. RESULTS FJR was performed at L3/L4 (N = 7), L4/L5 (N = 17), and L5/S1 (N = 2). Mean VAS (mm) for back pain decreased from 71 to 18, mean VAS for right leg pain from 61 to 7, and from 51 to 3 for the left leg. Mean ODI dropped from 51 to 22% (for all p < 0.01). Eighty seven percent of patients were satisfied and pretreatment activities were completely regained in 78.3% of patients. Disk height at the indicator and adjacent levels and ROM at the indicator segment and the entire lumbar spine were preserved. No loosening of implants was observed. Explantation of FJR and subsequent fusion had to be performed in four cases (15.4%). CONCLUSIONS In selected cases, long-term results of FJR show good outcome concerning pain, quality of life, preservation of lumbar spine motion, and protection of adjacent level.
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Affiliation(s)
- Ulrich J Knappe
- Department of Neurosurgery, Johannes Wesling Hospital, Ruhr-University Bochum, Minden, Germany
| | - David Reinecke
- Department of Neurosurgery, Johannes Wesling Hospital, Ruhr-University Bochum, Minden, Germany
| | - Michael Flörke
- Department of Neurosurgery, Johannes Wesling Hospital, Ruhr-University Bochum, Minden, Germany
| | - Peter Horn
- Department of Neurosurgery, Helios Dr. Horst Schmidt Hospital, Wiesbaden, Germany
| | - Robert Schönmayr
- Department of Neurosurgery, Helios Dr. Horst Schmidt Hospital, Wiesbaden, Germany
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Iwai H, Oshima Y, Kitagawa T, Inoue H, Takano Y, Inanami H, Koga H. A less invasive treatment by a full-endoscopic spine surgery for adjacent segment disease after lumbar interbody fusion. JOURNAL OF SPINE SURGERY 2020; 6:472-482. [PMID: 32656385 DOI: 10.21037/jss.2019.08.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Full-endoscopic spine surgery (FESS) is a suitable treatment for lumbar disc herniation (LDH) and foraminal stenosis. This study investigated the usefulness of FESS in treating adjacent segment disease (ASD) after lumbar interbody fusion (LIF). Methods Between September 2015 and March 2019, a total of 13 patients with symptomatic ASD after LIF underwent FESS. Discectomy and foraminoplasty using a 3.5-mm diameter high-speed drill were performed for treating LDH and foraminal stenosis. Preoperative and postoperative statuses were evaluated using Numerical Rating Scale (NRS) and the modified Japanese Orthopedic Association (mJOA) scores. Results The patients' mean age was 64.8 years; there were 10 male and 3 female patients. The mean operative time was 52.7 min. The mean pre- and postoperative NRS scores were 7.6 and 3.1, respectively. The mean pre- and postoperative mJOA scores were 10.5 and 16.1, respectively, and the mean recovery rate was 32.8%. Subsequent operative treatments were required in 3 patients for postoperative complication, insufficient decompression, and recurrence LDH. Conclusions FESS is a safe and effective minimally invasive treatment for ASD after LIF and a potential alternative to extend the LIF to the adjacent vertebra or sacrum.
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Affiliation(s)
- Hiroki Iwai
- Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Tomoaki Kitagawa
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirokazu Inoue
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Yuichi Takano
- Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hirohiko Inanami
- Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hisashi Koga
- Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
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Kolesov SV, Kazmin AI, Shvets VV, Gushcha AO, Poltorako EN, Basankin IV, Krivoshein AE, Bukhtin KM, Panteleev AA, Sazhnev ML, Pereverzev VS. Comparison of Nitinol and Titanium Nails Effectiveness for Lumbosacral Spine Fixation in Surgical Treatment of Degenerative Spine Diseases. ACTA ACUST UNITED AC 2019. [DOI: 10.21823/2311-2905-2019-25-2-59-70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Relevance. Surgical decompression and decompression with stabilization are highly effective for treatment of spinal canal stenosis at the level of lumbar spine. However, complications developing after application of rigid fixation systems resulted in active introduction of dynamic implants into clinical practice.Purpose of the study — to compare effectiveness of nitinol and titanium nails for lumbosacral fixation in surgical treatment of degenerative spine diseases.Materials and methods. 220 patients who underwent surgeries in 4 hospitals were randomized into two groups, each consisting of 110 patients (1:1 ratio): a group of patients who underwent stabilization of the vertebral motor segments with rods of nitinol with the required volume of decompression at the operation level and a group of patients who underwent stabilization of the vertebral motor segments with standard rods of titanium with the required volume of decompression at the intervention level. Patients suffered clinically significant spinal canal stenosis in one or two adjacent segments: from L3 to S1. Outcomes were evaluated during three years postoperatively by VAS scale for spine and lower limbs, and by ODI and SF-36 scales.Results. All scales demonstrated better values in both groups of patients, namely, significant decrease of pain syndrome and improvement in mental and physical health. X-ray examination of all patients during the study period demonstrated restoration of lumbar lordosis. Group of patients with dynamic nails featured less complications rate related to metal implants including adjacent segment disease.Conclusion. Transpedicular fixation of lumbosacral spine by nitinol nails is an effective technique allowing to preserve motion along with stable fixation.
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Affiliation(s)
- S. V. Kolesov
- Priorov National Medical Research Center of Traumatology and Orthopedics
| | - A. I. Kazmin
- Priorov National Medical Research Center of Traumatology and Orthopedics
| | - V. V. Shvets
- Priorov National Medical Research Center of Traumatology and Orthopedics
| | | | | | - I. V. Basankin
- Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1
| | | | - K. M. Bukhtin
- Priorov National Medical Research Center of Traumatology and Orthopedics
| | - A. A. Panteleev
- Priorov National Medical Research Center of Traumatology and Orthopedics
| | - M. L. Sazhnev
- Priorov National Medical Research Center of Traumatology and Orthopedics
| | - V. S. Pereverzev
- Priorov National Medical Research Center of Traumatology and Orthopedics
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Ushio S, Hirai T, Yoshii T, Inose H, Yuasa M, Kawabata S, Okawa A. Preoperative Risk Factors for Adjacent Segment Degeneration after Two-Level Floating Posterior Fusion at L3-L5. Spine Surg Relat Res 2019; 4:43-49. [PMID: 32039296 PMCID: PMC7002068 DOI: 10.22603/ssrr.2019-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/03/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction The aims of this study were to investigate how adjacent segment degeneration (ASD) occurs at the proximal and distal segments after L3-L5 fusion surgery, namely, floating fusion, and to identify the risk factors for ASD in patients who undergo this surgery. Methods Fifty patients who underwent floating fusion surgery at vertebrae L3-L5 and developed ASD were enrolled. The following parameters were evaluated: body mass index (BMI), diabetes status, dialysis status, lumbar lordosis, segmental lordosis between the L2 upper endplate and the L3 lower endplate, disc height, Cobb's angle, apical vertebral rotation using the Nash and Moe classification method, preoperative disc degeneration, surgical procedures, and the upper instrumented vertebra (UIV) tilt angle. The UIV tilt angle was defined as positive when the anterior side was directed caudally. Results Twenty-two (44%) of the 50 patients showed cephalad radiographic ASD (RASD) and 5 patients (10%) showed caudad RASD. Clinically symptomatic ASD was found at L2-L3 in 4 patients (8%) and at L5-S1 in 2 patients (4%). All the patients with clinically symptomatic cephalad ASD underwent revision procedures for radiculopathy or claudication because of degenerative pathology at L3-L4. Multivariate regression analysis showed a significant association of the absolute value of UIV tilt angle (mean |UIV tilt|) with cephalad RASD (odds ratio 1.09, p = 0.038). Receiver-operating characteristic curve analysis showed a significant association of |UIV tilt| >10.3° with RASD (sensitivity 67.9%, specificity 77.3%, area under the curve [AUC] 0.675). Conclusions RASD was more likely to occur at the adjacent segment on the cephalad side than at the adjacent segment on the caudad side after two-segment floating fusion of L3-L5. A preoperative UIV tilt angle >10° or UIV tilt < -10° was a risk factor for RASD.
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Affiliation(s)
- Shuta Ushio
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Hirai
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Inose
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahito Yuasa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigenori Kawabata
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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