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Etiology-Based Classification of Adjacent Segment Disease Following Lumbar Spine Fusion

  • CURRENT CONCEPTS IN SPINAL FUSION / ORIGINAL ARTICLE
  • Published:
HSS Journal ®

Abstract

Background

Adjacent segment disease (ASDz) is a potential complication following lumbar spinal fusion. A common nomenclature based on etiology and ASDz type does not exist and is needed to assist with clinical prognostication, decision making, and management.

Questions/Purposes

The objective of this study was to develop an etiology-based classification system for ASDz following lumbar fusion.

Methods

We conducted a retrospective chart review of 65 consecutive patients who had undergone both a lumbar fusion performed by a single surgeon and a subsequent procedure for ASDz. We established an etiology-based classification system for lumbar ASDz with the following six categories: “degenerative” (degenerative disc disease or spondylosis), “neurologic” (disc herniation, stenosis), “instability” (spondylolisthesis, rotatory subluxation), “deformity” (scoliosis, kyphosis), “complex” (fracture, infection), or “combined.” Based on this scheme, we determined the rate of ASDz in each etiologic category.

Results

Of the 65 patients, 27 (41.5%) underwent surgery for neurogenic claudication or radiculopathy for adjacent-level stenosis or disc herniation and were classified as “neurologic.” Ten patients (15.4%) had progressive degenerative disc pathology at the adjacent level and were classified as “degenerative.” Ten patients (15.4%) had spondylolisthesis or instability and were classified as “instability,” and three patients (4.6%) required revision surgery for adjacent-level kyphosis or scoliosis and were classified as “deformity.” Fifteen patients (23.1%) had multiple diagnoses that included a combination of categories and were classified as “combined.”

Conclusion

This is the first study to propose an etiology-based classification scheme of ASDz following lumbar spine fusion. This simple classification system may allow for the grouping and standardization of patients with similar pathologies and thus for more specific pre-operative diagnoses, personalized treatments, and improved outcome analyses.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 300, Chicago, IL, 60612, USA

    Philip K. Louie MD, Garrett K. Harada MD, Arash J. Sayari MD, Jannat M. Khan BS, Dino Samartzis DSc & Howard S. An MD

  2. Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA

    Benjamin C. Mayo MD

  3. Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA

    Arya G. Varthi MD

  4. Department of Orthopedic Surgery, Kaiser Permanente, Oakland, CA, USA

    Alem Yacob MD

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  1. Philip K. Louie MD
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Correspondence to Philip K. Louie MD.

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Conflict of Interest

Garrett K. Harada, MD, Arash J. Sayari, MD, Benjamin C. Mayo, MD, Jannat M. Khan, BS, Arya G. Varthi, MD, and Alem Yacob, MD, declare that they have no conflicts of interest. Philip K. Louie, MD, reports stock or stock options from StreaMD, outside the submitted work. Dino Samartzis, DSc, reports board or committee membership at AOSpine and International Society for the Study of the Lumbar Spine; publishing royalties from BMC Scoliosis and Spinal Disorders and Elsevier; and editorial or governing board membership from Global Spine Journal, Scoliosis and Spinal Disorders, and Spine Journal, outside the submitted work. Howard S. An, MD, reports royalties from U & I Corporation and Zimmer Biomet; stock ownership in Articular Engineering, Medyssey Inc., and Spinal Kinetics; consulting fees from Bioventus and Stryker; editorial board membership at American Journal of Orthopaedics and Spine Journal; and research support from Medyssey Inc. and SpinalCyte LLC, outside the submitted work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was waived from all patients for being included in this study.

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Level of Evidence: Level IV: Therapeutic Study

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Louie, P.K., Harada, G.K., Sayari, A.J. et al. Etiology-Based Classification of Adjacent Segment Disease Following Lumbar Spine Fusion. HSS Jrnl 16, 130–136 (2020). https://doi.org/10.1007/s11420-019-09723-w

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