Effect of pre-existing adjacent segment degeneration on short-term effectiveness after lumbar fusion surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Zhuoran ,  LI Weishi , GUO Yang , ZHOU Siyu , XU Fei , CHEN Zhongqiang , QI Qiang , GUO Zhaoqing , ZENG Yan , SUN Chuiguo

Department of Orthopaedics, Peking University Third Hospital, Beijing, 100191, P.R.China;

Corresponding author：

LI Weishi, Email: wslee72@163.com

Keywords：

Adjacent segment degeneration; pre-existing degeneration; degree of spinal stenosis; disc degeneration

DOI：

10.7507/1002-1892.201903114

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Objective To analyze the prospective effect of pre-existing spinal stenosis of adjacent segment on the short-term effectiveness after lumbar fusion surgery. Methods A prospective comparative study was conducted to divide 183 patients with L₄-S₁ lumbar spinal stenosis who met the selection criteria between July 2015 and December 2017 into two groups according to the status of adjacent segment degeneration (ASD) judged by preoperative disc degeneration and spinal stenosis. There were 98 patients in group A (no degeneration of adjacent segments before operation) and 85 patients in group B (adjacent segments degenerated before operation). There was no significant difference in gender, American Society of Anesthesiologists (ASA) grade, body mass index (BMI), combined spondylolisthesis, and preoperative visual analogue scale (VAS) score of low back pain and leg pain, Japanese Orthopaedic Association (JOA) score, and Oswestry disability index (ODI) score between the two groups (P>0.05); the age of group A was significantly younger than that of group B (t=−3.560, P=0.000). The operation time, intraoperative blood loss, hospitalization stay, and perioperative complications were recorded and compared. The VAS score of low back pain and leg pain, JOA score, and ODI score at last follow-up were used to evaluate the effectiveness. The incidence of ASD after operation was compared between the two groups, and logistic regression was used to analyze the independent risk factors affecting the occurrence of ASD after operation. Results There was no significant difference in operation time, intraoperative blood loss, and hospitalization stay between the two groups (P>0.05). The incidence of perioperative complications in groups A and B was 13.3% and 20.0%, respectively, with no significant difference (χ²=1.506, P=0.220). Two groups of patients were followed up, the follow-up time of groups A and B was (24.9±8.8) months and (24.8±7.8) months, respectively, there was no significant difference (t=0.050, P=0.960). At last follow-up, no adjacent segment disease was found in either group. There was no significant difference in Pfirrmann grade between the two groups at last follow-up (P>0.05), and there was significant difference in Pfirrmann grade between the two groups before operation and at last follow-up (P<0.001). At last follow-up, 21 cases (21.4%) in group A and 53 cases (62.4%) in group B had ASD, with significant difference (χ²=31.652, P=0.000). The main cause of ASD was the severity of adjacent spinal canal stenosis. The clinical scores of the two groups at last follow-up were significantly improved when compared with those before operation (P<0.05). The JOA score of group A was significantly higher than that of group B at last follow-up (P<0.05). In group B, the VAS score of low back pain and ODI score in patients with ASD after operation at last follow-up were significantly higher than those in patients without ASD (P<0.05). logistic regression analysis showed that preoperative pre-existing degeneration and BMI were independent risk factors for ASD after operation (P<0.05). Conclusion Pre-existing mild spinal stenosis in adjacent segment can significantly affect the effectiveness, and can significantly increase the risk of ASD early after operation. The main pathological type of ASD was the severity of adjacent segment spinal stenosis. For preoperative assessment of pre-existing degeneration, we should evaluate the overall degeneration of the adjacent segment of the spinal canal, rather than simply evaluating the degeneration of the adjacent disc and facet joints.

Citation： SUN Zhuoran, LI Weishi, GUO Yang, ZHOU Siyu, XU Fei, CHEN Zhongqiang, QI Qiang, GUO Zhaoqing, ZENG Yan, SUN Chuiguo. Effect of pre-existing adjacent segment degeneration on short-term effectiveness after lumbar fusion surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 837-844. doi: 10.7507/1002-1892.201903114 Copy

1.	朱迪, 李危石, 陈仲强, 等. 腰椎管狭窄症减压固定融合术后远期疗效及其影响因素分析. 中国脊柱脊髓杂志, 2013, 23(10): 865-871.
2.	Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976), 2004, 29(17): 1938-1944.
3.	Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J, 2004, 4(6 suppl): 190S-194S.
4.	Lund T, Oxland TR. Adjacent level disk disease—is it really a fusion disease? Orthop Clin North Am, 2011, 42(4): 529-541.
5.	Masevnin S, Ptashnikov D, Michaylov D, et al. Risk factors for adjacent segment disease development after lumbar fusion. Asian Spine J, 2015, 9(2): 239-244.
6.	Kim JY, Ryu DS, Paik HK, et al. Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion. Spine J, 2016, 16(7): 867-875.
7.	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(11): 1951-1960.
8.	Okuda S, Nagamoto Y, Matsumoto T, et al. Adjacent segment disease after single segment posterior lumbar interbody fusion for degenerative spondylolisthesis: minimum 10 years follow-up. Spine (Phila Pa 1976), 2018, 43(23): E1384-E1388.
9.	Lee GY, Lee JW, Choi HS, et al. A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal Radiol, 2011, 40(8): 1033-1039.
10.	Pfirrmann CW, Metzdorf A, Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976), 2001, 26(17): 1873-1878.
11.	Lee CS, Hwang CJ, Lee SW, et al. Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J, 2009, 18(11): 1637-1643.
12.	Okuda S, Iwasaki M, Miyauchi A, et al. Risk factors for adjacent segment degeneration after PLIF. Spine (Phila Pa 1976), 2004, 29(14): 1535-1540.
13.	Throckmorton TW, Hilibrand AS, Mencio GA, et al. The impact of adjacent level disc degeneration on health status outcomes following lumbar fusion. Spine (Phila Pa 1976), 2003, 28(22): 2546-2550.
14.	Nakashima H, Kawakami N, Tsuji T, et al. Adjacent segment disease after posterior lumbar interbody fusion: based on cases with a minimum of 10 years of follow-up. Spine (Phila Pa 1976), 2015, 40(14): E831-E841.
15.	Yugué I, Okada S, Masuda M, et al. Risk factors for adjacent segment pathology requiring additional surgery after single-level spinal fusion: impact of pre-existing spinal stenosis demonstrated by preoperative myelography. Eur Spine J, 2016, 25(5): 1542-1549.
16.	Park HJ, Kim SS, Lee YJ, et al. Clinical correlation of a new practical MRI method for assessing central lumbar spinal stenosis. Br J Radiol, 2013, 86(1025): 20120180.
17.	孙卓然, 周思宇, 郭扬, 等. 腰椎融合术前相邻节段退变对术后中长期临床疗效的影响. 中国脊柱脊髓杂志, 2019, 29(3): 193-199.
18.	Helgeson MD, Bevevino AJ, Hilibrand AS. Update on the evidence for adjacent segment degeneration and disease. Spine J, 2013, 13(3): 342-351.
19.	Hsieh YY, Chen CH, Tsuang FY, et al. Removal of fixation construct could mitigate adjacent segment stress after lumbosacral fusion: A finite element analysis. Clin Biomech (Bristol, Avon), 2017, 43: 115-120.
20.	Xia XP, Chen HL, Cheng HB. Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976), 2013, 38(7): 597-608.

1. 朱迪, 李危石, 陈仲强, 等. 腰椎管狭窄症减压固定融合术后远期疗效及其影响因素分析. 中国脊柱脊髓杂志, 2013, 23(10): 865-871.
2. Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976), 2004, 29(17): 1938-1944.
3. Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J, 2004, 4(6 suppl): 190S-194S.
4. Lund T, Oxland TR. Adjacent level disk disease—is it really a fusion disease? Orthop Clin North Am, 2011, 42(4): 529-541.
5. Masevnin S, Ptashnikov D, Michaylov D, et al. Risk factors for adjacent segment disease development after lumbar fusion. Asian Spine J, 2015, 9(2): 239-244.
6. Kim JY, Ryu DS, Paik HK, et al. Paraspinal muscle, facet joint, and disc problems: risk factors for adjacent segment degeneration after lumbar fusion. Spine J, 2016, 16(7): 867-875.
7. 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(11): 1951-1960.
8. Okuda S, Nagamoto Y, Matsumoto T, et al. Adjacent segment disease after single segment posterior lumbar interbody fusion for degenerative spondylolisthesis: minimum 10 years follow-up. Spine (Phila Pa 1976), 2018, 43(23): E1384-E1388.
9. Lee GY, Lee JW, Choi HS, et al. A new grading system of lumbar central canal stenosis on MRI: an easy and reliable method. Skeletal Radiol, 2011, 40(8): 1033-1039.
10. Pfirrmann CW, Metzdorf A, Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976), 2001, 26(17): 1873-1878.
11. Lee CS, Hwang CJ, Lee SW, et al. Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J, 2009, 18(11): 1637-1643.
12. Okuda S, Iwasaki M, Miyauchi A, et al. Risk factors for adjacent segment degeneration after PLIF. Spine (Phila Pa 1976), 2004, 29(14): 1535-1540.
13. Throckmorton TW, Hilibrand AS, Mencio GA, et al. The impact of adjacent level disc degeneration on health status outcomes following lumbar fusion. Spine (Phila Pa 1976), 2003, 28(22): 2546-2550.
14. Nakashima H, Kawakami N, Tsuji T, et al. Adjacent segment disease after posterior lumbar interbody fusion: based on cases with a minimum of 10 years of follow-up. Spine (Phila Pa 1976), 2015, 40(14): E831-E841.
15. Yugué I, Okada S, Masuda M, et al. Risk factors for adjacent segment pathology requiring additional surgery after single-level spinal fusion: impact of pre-existing spinal stenosis demonstrated by preoperative myelography. Eur Spine J, 2016, 25(5): 1542-1549.
16. Park HJ, Kim SS, Lee YJ, et al. Clinical correlation of a new practical MRI method for assessing central lumbar spinal stenosis. Br J Radiol, 2013, 86(1025): 20120180.
17. 孙卓然, 周思宇, 郭扬, 等. 腰椎融合术前相邻节段退变对术后中长期临床疗效的影响. 中国脊柱脊髓杂志, 2019, 29(3): 193-199.
18. Helgeson MD, Bevevino AJ, Hilibrand AS. Update on the evidence for adjacent segment degeneration and disease. Spine J, 2013, 13(3): 342-351.
19. Hsieh YY, Chen CH, Tsuang FY, et al. Removal of fixation construct could mitigate adjacent segment stress after lumbosacral fusion: A finite element analysis. Clin Biomech (Bristol, Avon), 2017, 43: 115-120.
20. Xia XP, Chen HL, Cheng HB. Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976), 2013, 38(7): 597-608.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of pre-existing adjacent segment degeneration on short-term effectiveness after lumbar fusion surgery

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