The influence of spinopelvic parameters on adjacent-segment degeneration after short spinal fusion for degenerative spondylolisthesis

OBJECTIVESpinopelvic parameters, such as the pelvic incidence (PI) angle, sacral slope angle, and pelvic tilt angle, are important anatomical indices for determining the sagittal curvature of the spine and the individual variability of the lumbar lordosis (LL) curve. The aim of this study was to investigate the influence of spinopelvic parameters and LL on adjacent-segment degeneration (ASD) after short lumbar and lumbosacral fusion for single-level degenerative spondylolisthesis.METHODSThe authors retrospectively reviewed the records of all short lumbar and lumbosacral fusion surgeries performed between August 2003 and July 2010 for single-level degenerative spondylolisthesis in their orthopedic department.RESULTSA total of 30 patients (21 women and 9 men, mean age 64 years) with ASD after lower lumbar or lumbosacral fusion surgery comprised the study group. Thirty matched patients (21 women and 9 men, mean age 63 years) without ASD comprised the control group, according to the following matching criteria: same diagnosis on admission, similar pathologic level (≤ 1 level difference), similar sex, and age. The average follow-up was 6.8 years (range 5–8 years). The spinopelvic parameters had no significant influence on ASD after short spinal fusion.CONCLUSIONSNeither the spinopelvic parameters nor a mismatch of PI and LL were significant factors responsible for ASD after short spinal fusion due to single-level degenerative spondylolisthesis.

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Predicting factors of adjacent segment degeneration after long-segment spinal fusion: spinopelvic parameters analysis

10.21203/rs.2.18590/v1 ◽

2019 ◽

Author(s):

Ping-Yeh Chiu ◽

Fu-Cheng Kao ◽

Wen-Jer Chen ◽

Chia-Wei Yu ◽

Chi-Chien Niu ◽

...

Keyword(s):

Spinal Fusion ◽

Lumbar Fusion ◽

Slope Angle ◽

Adjacent Segment Degeneration ◽

Control Group ◽

Adjacent Segment ◽

Spinopelvic Parameters ◽

Significant Difference ◽

Adjacent Disc

Abstract Purpose We investigated whether spinopelvic parameters are important prognostic factors for adjacent segment degeneration after long instrumented spinal fusion for degenerative spinal disease. Methods This uncontrolled, randomized, single arm retrospective study included patients who underwent long instrumented lumbar fusion (fusion levels≥ 4) in the past 5 years with follow-up for at least 2 years. The inclusion criteria included adult patients (≥40 years of age) with a diagnosis of spinal degeneration who underwent instrumented corrective surgery. The exclusion criteria included preexisting adjacent disc degeneration, combined anterior reconstructive surgery, and distal ASD. Clinical and operative characters were evaluated. Lumbar lordotic angle (LLA), sacral slope angle (SSA), pelvic tilt angle (PTA) and pelvic incidence angle (PIA) were compared preoperatively, postoperatively and at the final follow-up. Results From 2009 to 2014, 60 patients (30 ASD and 30 non-ASD patients) were enrolled. The average age was 66.82 ± 7.48 years for the study group and 67.97 ± 7.81 years for the control group. There was no statistically significant difference in clinical and operative characteristics. Among all spinopelvic parameters, only pre-, post-operative and final follow-up PIA in ASD group (53.9±10.4ﾟ, 54.6±14.0ﾟ, 54.3±14.1ﾟ) and non-ASD group (60.3±13.0ﾟ, 61.8±11.3ﾟ, 62.5±11.2ﾟ) showed statistically significant differences (p<0.05). Conclusion This study confirms that preoperative, postoperative and final follow-up PIA is a significant factor contributing to the development of adjacent segment degeneration after long instrumented spinal fusion.

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Predicting factors of adjacent segment degeneration after long-segment spinal fusion: spinopelvic parameters analysis

10.21203/rs.2.18590/v2 ◽

2020 ◽

Author(s):

Ping-Yeh Chiu ◽

Fu-Cheng Kao ◽

Wen-Jer Chen ◽

Chia-Wei Yu ◽

Chi-Chien Niu ◽

...

Keyword(s):

Spinal Fusion ◽

Lumbar Fusion ◽

Adjacent Segment Degeneration ◽

Control Group ◽

Sacral Slope ◽

Adjacent Segment ◽

Spinopelvic Parameters ◽

Significant Difference ◽

Adjacent Disc

Abstract Background We investigated whether spinopelvic parameters are important prognostic factors causing adjacent segment degeneration (ASD) after long instrumented spinal fusion for degenerative spinal disease. Methods This uncontrolled, randomized, single arm retrospective study included patients who underwent long instrumented lumbar fusion (fusion levels≥ 4) in the past 5 years with follow-up for at least 2 years. The inclusion criteria included adult patients (≥40 years of age) with a diagnosis of spinal degeneration who underwent instrumented corrective surgery. The exclusion criteria included preexisting adjacent disc degeneration, combined anterior reconstructive surgery, and distal ASD. Clinical and operative characters were evaluated. Angle of lumbar lordosis (LLA), sacral slope (SSA), pelvic tilt (PTA) and pelvic incidence (PIA) were compared preoperatively, postoperatively and at the final follow-up. Results From 2009 to 2014, 60 patients (30 ASD and 30 non-ASD) were enrolled. The average age was 66.82 ± 7.48 years for the study group and 67.97 ± 7.81 years for the control group. There was no statistically significant difference in clinical and operative characteristics. Among all spinopelvic parameters, only pre-, post-operative and final follow-up PIA in ASD group (53.9±10.4ﾟ, 54.6±14.0ﾟ, 54.3±14.1ﾟ) and non-ASD group (60.3±13.0ﾟ, 61.8±11.3ﾟ, 62.5±11.2ﾟ) showed statistically significant differences ( p <0.05). Conclusion This study confirms that preoperative, postoperative and final follow-up PIA is a significant factor contributing to the development of ASD after long instrumented spinal fusion.

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Is the Goutallier grade of multifidus fat infiltration associated with adjacent-segment degeneration after lumbar spinal fusion?

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20238 ◽

2020 ◽

pp. 1-6

Author(s):

Ping-Guo Duan ◽

Praveen V. Mummaneni ◽

Jeremy M. V. Guinn ◽

Joshua Rivera ◽

Sigurd H. Berven ◽

...

Keyword(s):

Revision Surgery ◽

Demographic Data ◽

Degenerative Spondylolisthesis ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Fat Infiltration ◽

Single Level ◽

Goutallier Classification ◽

Spinopelvic Parameter

OBJECTIVEThe aim of this study was to investigate whether fat infiltration of the lumbar multifidus (LM) muscle affects revision surgery rates for adjacent-segment degeneration (ASD) after L4–5 transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis.METHODSA total of 178 patients undergoing single-level L4–5 TLIF for spondylolisthesis (2006 to 2016) were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, preoperative MR images and radiographs, and single-level L4–5 TLIF for degenerative spondylolisthesis. Twenty-three patients underwent revision surgery for ASD during the follow-up. Another 23 patients without ASD were matched with the patients with ASD. Demographic data, Roussouly curvature type, and spinopelvic parameter data were collected. The fat infiltration of the LM muscle (L3, L4, and L5) was evaluated on preoperative MRI using the Goutallier classification system.RESULTSA total of 46 patients were evaluated. There were no differences in age, sex, BMI, or spinopelvic parameters with regard to patients with and those without ASD (p > 0.05). Fat infiltration of the LM was significantly greater in the patients with ASD than in those without ASD (p = 0.029). Fat infiltration was most significant at L3 in patients with ASD than in patients without ASD (p = 0.017). At L4 and L5, there was an increasing trend of fat infiltration in the patients with ASD than in those without ASD, but the difference was not statistically significant (p = 0.354 for L4 and p = 0.077 for L5).CONCLUSIONSFat infiltration of the LM may be associated with ASD after L4–5 TLIF for spondylolisthesis. Fat infiltration at L3 may also be associated with ASD at L3–4 after L4–5 TLIF.

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Adjacent Segment Degeneration after Single-Level PLIF: Comparison between Spondylolytic Spondylolisthesis, Degenerative Spondylolisthesis and Spinal Stenosis

Asian Spine Journal ◽

10.4184/asj.2011.5.2.82 ◽

2011 ◽

Vol 5 (2) ◽

pp. 82 ◽

Cited By ~ 9

Author(s):

Chang Hun Yu ◽

Jung Eun Lee ◽

Jae Jun Yang ◽

Bong-Soon Chang ◽

Choon-Ki Lee

Keyword(s):

Spinal Stenosis ◽

Degenerative Spondylolisthesis ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Single Level ◽

Spondylolytic Spondylolisthesis

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Effect of Coflex interspinous stabilization on the prevention of progression of adjacent segment degeneration after single level and skipped level spinal fusion in a canine model

10.21203/rs.2.12549/v1 ◽

2019 ◽

Author(s):

Jia-ming Liang ◽

Fang-qi Lin ◽

Jia-ning Ding ◽

Jian-guang Xu

Keyword(s):

Spinal Fusion ◽

Real Time ◽

Real Time Pcr ◽

Interbody Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Middle Segment ◽

Single Level ◽

Matrix Gene

Abstract Background Interspinous spacer (ISPs) was a promising treatment method for adjacent segment degeneration (ASD) after spinal fusion. Coflex, one of ISPs, has been deceived to prevent or decelerate ASD after spinal fusion, while the proof of the effectiveness of such device is still very limited. The purpose of this study was further to investigate the protection role of Coflex in vivo after spinal fusion, when implanted in adjacent segment and middle segment. Methods Three groups of beagles were allocated as follows (n=6): (1)L4-5 lumbar interbody fusion(IF). (2) L4-5 lumbar interbody fusion +L5-6 interspinous Coflex implantation(Cof1).(3) L4-5 and L6-7 interbody fusion+ L5-6 interspinous Coflex implantation (Cof2). In all animals, L5-6 discs were punctured to generate degeneration, and the intact L2–3 disc served as a noninjuries control (Con group). The effectiveness of Coflex on the prevention or deceleration of the progression of ASD was determined by magnetic resonance imaging, gross anatomical observation, histological and immunohistochemically analysis, and Real-time PCR analysis of gene expression. Results The objective disc in every group showed degeneration, however, the degeneration was more significant in IF group than Cof1 and Cof2 groups. MRI and histologic assay demonstrated that the discs of Cof1 and Cof2 groups maintained a relatively well-preserved structure as compared to the discs of IF group. Furthermore, immunohistochemistry analysis and real-time PCR demonstrated that the indicators of disc degeneration, TIMP1, BMP2, Col I, were up-regulated and disc matrix gene, Col II was down-regulated in IF group significantly Conclusions Coflex could decelerate the progression of ASD after spinal fusion, and it holds the same value not only at adjacent segment after single level spinal fusion, but also dose at the middle segment after “skipped” level (nonconsecutive) fusion

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Adjacent Segment Degeneration after Single-level Posterior Lumbar Interbody Fusion - Comparison between Spondylolytic Spondylolisthesis, Degenerative Spondylolisthesis, and Spinal Stenosis

The Spine Journal ◽

10.1016/j.spinee.2010.07.072 ◽

2010 ◽

Vol 10 (9) ◽

pp. S24-S25

Author(s):

Chang Hun Yu ◽

Bong-Soon Chang ◽

Jae Jun Yang ◽

Jung E. Lee ◽

Choon-Ki Lee

Keyword(s):

Spinal Stenosis ◽

Interbody Fusion ◽

Degenerative Spondylolisthesis ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Single Level ◽

Spondylolytic Spondylolisthesis

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Obesity may be associated with adjacent-segment degeneration after single-level transforaminal lumbar interbody fusion in spinopelvic-mismatched patients with a minimum 2-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20159 ◽

2021 ◽

Vol 34 (1) ◽

pp. 83-88

Author(s):

Ping-Guo Duan ◽

Praveen V. Mummaneni ◽

Minghao Wang ◽

Andrew K. Chan ◽

Bo Li ◽

...

Keyword(s):

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Inclusion Criteria ◽

Single Level ◽

Degenerative Lumbar Spondylolisthesis ◽

Surgery Rates

OBJECTIVEIn this study, the authors’ aim was to investigate whether obesity affects surgery rates for adjacent-segment degeneration (ASD) after transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis.METHODSPatients who underwent single-level TLIF for spondylolisthesis at the University of California, San Francisco, from 2006 to 2016 were retrospectively analyzed. Inclusion criteria were a minimum 2-year follow-up, single-level TLIF, and degenerative lumbar spondylolisthesis. Exclusion criteria were trauma, tumor, infection, multilevel fusions, non-TLIF fusions, or less than a 2-year follow-up. Patient demographic data were collected, and an analysis of spinopelvic parameters was performed. The patients were divided into two groups: mismatched, or pelvic incidence (PI) minus lumbar lordosis (LL) ≥ 10°; and balanced, or PI-LL < 10°. Within the two groups, the patients were further classified by BMI (< 30 and ≥ 30 kg/m2). Patients were then evaluated for surgery for ASD, matched by BMI and PI-LL parameters.RESULTSA total of 190 patients met inclusion criteria (72 males and 118 females, mean age 59.57 ± 12.39 years). The average follow-up was 40.21 ± 20.42 months (range 24–135 months). In total, 24 patients (12.63% of 190) underwent surgery for ASD. Within the entire cohort, 82 patients were in the mismatched group, and 108 patients were in the balanced group. Within the mismatched group, adjacent-segment surgeries occurred at the following rates: BMI < 30 kg/m2, 2.1% (1/48); and BMI ≥ 30 kg/m2, 17.6% (6/34). Significant differences were seen between patients with BMI ≥ 30 and BMI < 30 (p = 0.018). A receiver operating characteristic curve for BMI as a predictor for ASD was established, with an AUC of 0.69 (95% CI 0.49–0.90). The optimal BMI cutoff value determined by the Youden index is 29.95 (sensitivity 0.857; specificity 0.627). However, in the balanced PI-LL group (108/190 patients), there was no difference in surgery rates for ASD among the patients with different BMIs (p > 0.05).CONCLUSIONSIn patients who have a PI-LL mismatch, obesity may be associated with an increased risk of surgery for ASD after TLIF, but in obese patients without PI-LL mismatch, this association was not observed.

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Repeated adjacent-segment degeneration after posterior lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2014.2.spine13800 ◽

2014 ◽

Vol 20 (5) ◽

pp. 538-541 ◽

Cited By ~ 10

Author(s):

Shinya Okuda ◽

Takenori Oda ◽

Ryoji Yamasaki ◽

Takafumi Maeno ◽

Motoki Iwasaki

Keyword(s):

Interbody Fusion ◽

Degenerative Spondylolisthesis ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment Degeneration ◽

Long Term Results ◽

Sacral Slope ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Primary Operation ◽

The Third

One of the most important sequelae affecting long-term results is adjacent-segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF). Although several reports have described the incidence rate, there have been no reports of repeated ASD. The purpose of this report was to describe 1 case of repeated ASD after PLIF. A 62-year-old woman with L-4 degenerative spondylolisthesis underwent PLIF at L4–5. At the second operation, L3–4 PLIF was performed for L-3 degenerative spondylolisthesis 6 years after the primary operation. At the third operation, L2–3 PLIF was performed for L-2 degenerative spondylolisthesis 1.5 years after the primary operation. Vertebral collapse of L-1 was detected 1 year after the third operation, and the collapse had progressed. At the fourth operation, 3 years after the third operation, vertebral column resection of L-1 and replacement of titanium mesh cages with pedicle screw fixation between T-4 and L-5 was performed. Although the patient's symptoms resolved after each operation, the time between surgeries shortened. The sacral slope decreased gradually although each PLIF achieved local lordosis at the fused segment.

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