Skip to main content
SpringerLink
Log in

The fate of adjacent segments with pre-existing degeneration after lumbar posterolateral fusion: the influence of degenerative grading

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the impact of pre-existing disc degeneration and its extent on future adjacent segment degeneration (ASDeg) after lumbar posterolateral fusion (PLF).

Methods

A total of 102 patients who had undergone PLF for degenerative lumbar diseases from January 2006 to December 2008 were retrospectively reviewed by using radiography and clinical evaluation. The University of California at Los Angeles (UCLA) grading scale was used to evaluate the extent of disc degeneration. The Visual Analog Scale, Oswestry Disability Index, and SF-36 questionnaire were used to evaluate clinical outcomes.

Results

The overall prevalence of radiological ASDeg was 25.5 %, and the prevalence of ASDeg for the cranial and caudal levels was 19.6 and 15.1 %, respectively. The prevalence of ASDeg in one-, two-, and three-level fusion was 15.8, 26.3, and 50 %, respectively (p = 0.008). For the cranial level, the preoperative UCLA grade A, B, and C groups had prevalence values for ASDeg of 13.5, 28.6, and 42.9 %, respectively (p = 0.026). A higher prevalence of ASDeg was found in cranial discs with pre-existing degeneration than in the group without pre-existing degeneration (p = 0.012). The group without pre-existing degeneration showed better outcomes. For the caudal level, there was no significant difference in ASDeg prevalence. At final follow-up, the group without pre-existing disc degeneration showed better outcomes than the group with pre-existing disc degeneration.

Conclusions

Adjacent segment discs with pre-existing degeneration had a higher likelihood of ASDeg progression compared with normal discs, especially for those classified as UCLA grade C.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kumar MN, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Etebar S, Cahill DW (1999) Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg 90:163–169

    CAS  PubMed  Google Scholar 

  3. Nagata H, Schendel MJ, Transfeldt EE, Lewis JL (1993) The effects of immobilization of long segments of the spine on the adjacent and distal facet force and lumbosacral motion. Spine 18:2471–2479

    Article  CAS  PubMed  Google Scholar 

  4. Wiltse LL, Radecki SE, Biel HM, DiMartino PP, Oas RA, Farjalla G, Ravessoud FA, Wohletz C (1999) Comparative study of the incidence and severity of degenerative change in the transition zones after instrumented versus noninstrumented fusions of the lumbar spine. J Spinal Disord 12:27–33

    Article  CAS  PubMed  Google Scholar 

  5. Bastian L, Lange U, Knop C, Tusch G, Blauth M (2001) Evaluation of the mobility of adjacent segments after posterior thoracolumbar fixation: a biomechanical study. Eur Spine J 10:295–300

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Chen CS, Cheng CK, Liu CL (2002) A biomechanical comparison of posterolateral fusion and posterior fusion in the lumbar spine. J Spinal Disord Tech 15:53–63

    Article  PubMed  Google Scholar 

  7. Rao RD, David KS, Wang M (2005) Biomechanical changes at adjacent segments following anterior lumbar interbody fusion using tapered cages. Spine 30:2772–2776

    Article  PubMed  Google Scholar 

  8. Wai EK, Santos ERG, Morcom RA, Fraser RD (2006) Magnetic resonance imaging 20 years after anterior lumbar interbody fusion. Spine 31:1952–1956

    Article  PubMed  Google Scholar 

  9. Ghiselli G, Wang JC, Hsu WK, Dawson EG (2003) L5–S1 segment survivorship and clinical outcome analysis after L4–L5 isolated fusion. Spine 28:1275–1280

    PubMed  Google Scholar 

  10. Liao JC, Chen WJ, Chen LH, Niu CC (2009) Outcome of the L5–S1 segment after posterior instrumented spinal surgery in degenerative lumbar diseases. Chang Gung Med J 32:81–88

    PubMed  Google Scholar 

  11. Mimura M, Panjabi MM, Oxland TR, Crisco JJ, Yamamoto I, Vasavada A (1994) Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine 19:1371–1380

    Article  CAS  PubMed  Google Scholar 

  12. Macdermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, Goldsmith CH (2009) Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther 39:400–417

    Article  PubMed  Google Scholar 

  13. Ware JE Jr (2000) SF-36 health survey update. Spine 25:3130–3139

    Article  PubMed  Google Scholar 

  14. Ghiselli G, Wang JC, Bhatia NN, Hsu WK, Dawson EG (2004) Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am 86:1497–1503

    PubMed  Google Scholar 

  15. Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT (1997) 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22:2807–2812

    Article  CAS  PubMed  Google Scholar 

  16. Simmons ED Jr, Simmons EH (1992) Spinal stenosis with scoliosis. Spine 17:S117–S120

    Article  PubMed  Google Scholar 

  17. Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE (2004) Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 29:1938–1944

    Article  PubMed  Google Scholar 

  18. Miyakoshi N, Abe E, Shimada Y, Okuyama K, Suzuki T, Sato K (2000) Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. Spine 25:1837–1842

    Article  CAS  PubMed  Google Scholar 

  19. Kumar MN, Jacquot F, Hall H (2001) Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease. Eur Spine J 10:309–313

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Radcliff K, Curry P, Hilibrand A, Kepler C, Lurie J, Zhao W, Albert TJ, Weinstein J (2013) Risk for adjacent segment and same segment reoperation after surgery for lumbar stenosis: a subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine 38:531–539

    Article  PubMed Central  PubMed  Google Scholar 

  21. Kornblum MB, Fischgrund JS, Herkowitz HN, Abraham DA, Berkower DL, Ditkoff JS (2004) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis. Spine 29:726–733

    Article  PubMed  Google Scholar 

  22. Aiki H, Ohwada O, Kobayashi H, Hayakawa M, Kawaguchi S, Takebayashi T, Yamashita T (2005) Adjacent segment stenosis after lumbar fusion requiring second operation. J Orthop Sci 10:490–495

    Article  PubMed  Google Scholar 

  23. Gillet P (2003) The fate of the adjacent motion segments after lumbar fusion. J Spinal Disord Tech 16:338–345

    Article  PubMed  Google Scholar 

  24. Umehara S, Zindrick MR, Patwardhan AG, Havey RM, Vrbos LA, Knight GW, Miyano S, Kirincic M, Kaneda K, Lorenz MA (2000) The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine 25:1617–1624

    Article  CAS  PubMed  Google Scholar 

  25. Chen CS, Feng CK, Cheng CK, Tzeng MJ, Liu CL, Chen WJ (2005) Biomechanical analysis of the disc adjacent to posterolateral fusion with laminectomy in lumbar spine. J Spinal Disord Tech 18:58–65

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, People’s Republic of China

    Chao Li

  2. Department of Orthopaedics, Navy General Hospital, Beijing, 100048, People’s Republic of China

    Chao Li, Qing He, Yong Tang & Dike Ruan

Authors
  1. Chao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qing He
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yong Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dike Ruan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dike Ruan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, C., He, Q., Tang, Y. et al. The fate of adjacent segments with pre-existing degeneration after lumbar posterolateral fusion: the influence of degenerative grading. Eur Spine J 24, 2468–2473 (2015). https://doi.org/10.1007/s00586-015-3921-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-015-3921-2

Keywords

Search

Navigation