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Risk factors for mechanical complications after fusion extension surgery for lumbar adjacent segment disease

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Abstract

Purpose

Adjacent segment disease (ASD) is a common complication in fusion surgery. In the event of solid segmental fusion, previous implants can be removed or preserved during fusion extension for ASD. To compare the surgical outcomes of patients with and without implants and analyzes the risk factors for postoperative mechanical complications.

Methods

Patients who underwent fusion extension for lumbar ASD from 2011 to 2019 with a minimum 2 year follow-up were retrospectively reviewed. Spinopelvic parameters were measured preoperatively and postoperatively. Clinical outcomes and surgical complications were compared between groups with implants preserved and removed. Risk factors for mechanical complications, including clinical, surgical, and radiographic factors were analyzed.

Results

Sixty-nine patients (mean age, 69.9 ± 6.9 years) were included. The mean numbers of initial and extended fused segments were 2.8 ± 0.7 and 2.7 ± 0.7, respectively. Previous implants were removed in 43 patients (R group) and preserved in 26 patients (P group). Both groups showed an improvement in clinical outcomes without between-group differences. The operation time was significantly longer in R group (260 vs 207 min, p < 0.001). Mechanical complications occurred in 13 patients (12 in R group and 1 in P group) and reoperation was needed in 3 patients (R group). Implant removal, index fusion surgery including L5-S1, and postoperative sagittal malalignment were risk factors for mechanical complications.

Conclusion

Implant removal was a risk factor for mechanical complications. Index fusion surgery including L5-S1 and postoperative sagittal malalignment were also risk factors for mechanical complications.

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Acknowledgements

The author wishes to acknowledge the financial support of the Catholic Medical Center Research Foundation made in the program year of 2022.

Funding

The author wishes to acknowledge the financial support of the Catholic Medical Center Research Foundation made in the program year of 2022.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Korea

    Young-Hoon Kim, Jae-Hak Lim & Sang-Il Kim

  2. Department of Orthopedic Surgery, Kyung-Hee University Hospital at Gangdong, Kyung-Hee University, Seoul, Korea

    Kee-Yong Ha

  3. Department of Orthopedic Surgery, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea

    Joonghyun Ahn

  4. Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea

    Hyung-Youl Park

  5. Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University, Seoul, Korea

    Dong-Gune Chang

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  1. Young-Hoon Kim
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Correspondence to Sang-Il Kim.

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Kim, YH., Ha, KY., Ahn, J. et al. Risk factors for mechanical complications after fusion extension surgery for lumbar adjacent segment disease. Eur Spine J 33, 324–331 (2024). https://doi.org/10.1007/s00586-023-07880-5

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  • DOI: https://doi.org/10.1007/s00586-023-07880-5

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