European Spine Journal

, Volume 25, Issue 5, pp 1550–1557 | Cite as

Adjacent segment degeneration and revision surgery after circumferential lumbar fusion: outcomes throughout 15 years of follow-up

  • José I. Maruenda
  • Carlos BarriosEmail author
  • Felipe Garibo
  • Borja Maruenda
Original Article



This retrospective study analyzes long-term outcomes (15 years) of circumferential lumbar fusion (CF) for degenerative spine disease using instrumented PLIF. The occurrence of adjacent segment degeneration (ASD) and the reintervention rate was specially focused.


A series of 73 patients who underwent CF (1–3 levels) was reviewed. Patients were evaluated preoperatively, at 2, 5, 10 and 15 years after surgery with static and dynamic radiographic studies, CT scan and MRI. Patients completed also the Oswestry-Disability index (ODI), the VAS score, and the patient self-satisfaction questionnaire.


At 2-year follow-up, there was a decrease in the average ODI score (from 72.3 ± 16.4 preop to 30.5 ± 6.2). At 10- and 15-year follow-up, ODI scores return to preoperative scores in patients without revision surgery. The 82.8 % of patients referred an excellentgood self-satisfaction rate at this time. At 5-year follow-up, seven patients (9.6 %) required reoperation because of symptomatic ASD. At 10-year follow-up, reoperated patients increased to 24.6 % (18 cases). Excellent and good self-satisfaction rate decreased to 41.1 % at this time. Radiological ASD was then detected in 37 cases (50.7 %). At 15-year follow-up, nine patients were lost and a total of 24 (37.5 %) required a new surgical treatment because of ASD. The occurrence of revision surgery because of symptomatic ASD was highly dependent of the age of patients at the first surgery and the number of fused levels.


Circumferential lumbar fusion provides good clinical results at short-term follow-up. From 2- to 15-year follow-up, outcome worsened significantly. The high rate of ASD occurrence and reintervention questions the reliability of this technique for lumbar fusion.


Degenerative spine disease Circumferential lumbar fusion Adjacent segment degeneration Revision surgery 


Compliance with ethical standards

Conflict of interest

No conflict of interest.


  1. 1.
    Fritzell P, Hagg O, Wessberg P et al (2001) 2001 Volvo Award Winner in Clinical Studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine 26:2521–2532CrossRefPubMedGoogle Scholar
  2. 2.
    Fritzell P, Hagg O, Wessberg P et al (2002) Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish Lumbar Spine Study Group. Spine 27:1131–1141CrossRefPubMedGoogle Scholar
  3. 3.
    Hsieh PC, Koski TR, O’Shaughnessy BA et al (2007) Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg 7:379–386Google Scholar
  4. 4.
    Gertzbein SD, Betz R, Clements D et al (1996) Semirigid instrumentation in the management of lumbar spinal conditions combined with circumferential fusion: a multicenter study. Spine 21:1918–1925CrossRefPubMedGoogle Scholar
  5. 5.
    Kozak JA, O’Brien JP (1990) Simultaneous combined anterior and posterior fusion: an independent analysis of a treatment for the disabled low back pain patient. Spine 15:322–328CrossRefPubMedGoogle Scholar
  6. 6.
    Ht Hee, Castro FP Jr, Majd ME et al (2001) Anterior/posterior lumbar fusion versus transforaminal lumbar interbody fusion: analysis of complications and predictive factors. J Spinal Disord 14:533–540CrossRefGoogle Scholar
  7. 7.
    Steffee AD, Brantigan JW (1993) The variable screw placement spinal fixation system. Report of a prospective study of 250 patients enrolled in food and drug administration clinical trials. Spine 18:1160–1172CrossRefPubMedGoogle Scholar
  8. 8.
    Enker P, Steffee AD (1994) Interbody fusion and instrumentation. Clin Orthop 300:90–101PubMedGoogle Scholar
  9. 9.
    Kumar MN, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Cutler AR, Siddiqui S, Mohan AL et al (2006) Comparison of polyetheretherketone cages with femoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion. J Neurosurg 5:534–539Google Scholar
  11. 11.
    La Rosa G, Conti A, Cacciola F et al (2003) Pedicle screw fixation for isthmic spondylolisthesis: dose posterior lumbar interbody fusion improve outcome over posterolateral fusion? J Neurosurg (Spine 2) 99(2 suppl):143–150CrossRefGoogle Scholar
  12. 12.
    Soegaard R, Bunger CE, Christiansen T et al (2007) Circumferential fusion is dominant over posterolateral fusion in a long-term perspective: cost-utility evaluation of a randomized controlled trial in severe, chronic low back pain. Spine 32:2405–2414CrossRefPubMedGoogle Scholar
  13. 13.
    Videbaek TS, Christensen FB, Soegaard R et al (2006) Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion: long-term results of a randomized clinical trial. Spine 31:2875–2880CrossRefPubMedGoogle Scholar
  14. 14.
    Madan SS, Boeree NR (2003) Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusión. Eur Spine J 12:567–575CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Suk S, Lee C-K, Kim W-J, Lee J-H, Cho K-J, Kim H-G (1997) Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine 22:210–220CrossRefPubMedGoogle Scholar
  16. 16.
    Gibson JN, Grant IC, Waddell G (1999) The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine 24:1820–1832CrossRefPubMedGoogle Scholar
  17. 17.
    Rosenberg WS, Mummaneni PV (2001) Transforaminal lumbar interbody fusion: technique, complications, and early results. Neurosurgery 48:569–575CrossRefPubMedGoogle Scholar
  18. 18.
    Christensen FB, Hansen ES, Eiskjaer SP et al (2002) Circumferential lumbar spinal fusion with Brantigan cage versus posterolateral fusion with titanium Cotrel-Dubousset instrumentation: a prospective, randomized clinical study of 146 patients. Spine 27:2674–2683CrossRefPubMedGoogle Scholar
  19. 19.
    Kim KT, Lee SH, Lee YH, Bae SC, Suk KS (2006) Clinical outcomes of three fusion methods through the posterior approach in the lumbar spine. Spine 31:1351–1357CrossRefPubMedGoogle Scholar
  20. 20.
    Lee CS, Hwang CJ, Lee DH, Kim YT, Lee HS (2011) Fusion rates of instrumented lumbar spinal arthrodesis according to surgi-cal approach: a systematic review of randomized trials. Clin Orthop Surg 3:39–47CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Ekman P, Moller H, Tullberg T, Neumann P, Hedlund R (2007) Posterior lumbar interbody fusion versus posterolateral fusion inadult isthmic spondylolisthesis. Spine 32:2178–2183CrossRefPubMedGoogle Scholar
  22. 22.
    Nakai S, Yoshizawa H, Kobayashi S (1999) Long-term follow-up study of posterior lumbar interbodey fusion. J Spinal Disord 12:293–299CrossRefPubMedGoogle Scholar
  23. 23.
    Harrop JS, Youssef JA, Maltenfort M, Vorwald P, Jabbour P, Bono CM, Goldfarb N, Vaccaro AR, Hilibrand AS (2008) Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine 33:1701–1707CrossRefPubMedGoogle Scholar
  24. 24.
    Hassett G, Hart DJ, Manek NJ et al (2003) Risk factors for progression of lumbar spine disc degeneration: the Chingford study. Arthritis Rheum 48:3112–3117CrossRefPubMedGoogle Scholar
  25. 25.
    Ghiselli G, Wang J, Bhatia N et al (2004) Adjacent segment degeneration in the lumbar spine. J Bone Jt Surg Am 86:1497–1503Google Scholar
  26. 26.
    Heo Y, Park JH, Seong HY et al (2015) Symptomatic adjacent segment degeneration at the L3–4 level after fusion surgery at the L4–5 level: evaluation of the risk factors and 10-year incidence. Eur Spine J 24:2474–2480CrossRefPubMedGoogle Scholar
  27. 27.
    Choi KC, Kim JS, Shim HK et al (2014) Changes in the adjacent segment 10 years after anterior lumbar interbody fusion for low-grade isthmic spondylolisthesis. Clin Orthop Relat Res 472:1845–1854CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kim TH, Lee BH, Moon SH, Lee SH, Lee HM (2013) Comparison of adjacent segment degeneration after successful posterolateral fusion with unilateral or bilateral pedicle screw instrumentation: a minimum 10-year follow-up. Spine J 13:1208–1216CrossRefPubMedGoogle Scholar
  29. 29.
    Di Martino A, Cosimo Quattrocchi C et al (2014) Estimating the risk for symptomatic adjacent segment degeneration after lumbar fusion: analysis from a cohort of patients undergoing revision surgery. Eur Spine J 23(Suppl 6):S693–S698CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • José I. Maruenda
    • 1
  • Carlos Barrios
    • 2
    Email author
  • Felipe Garibo
    • 1
  • Borja Maruenda
    • 3
  1. 1.Department of Orthopedic SurgeryUniversity Clinic HospitalValenciaSpain
  2. 2.Institute for Research on Musculoskeletal DisordersValencia Catholic UniversityValenciaSpain
  3. 3.Department of Orthopedic SurgeryHospital Universitario de la RiberaAlziraSpain

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