Skip to main content
SpringerLink
Log in

Adjacent segment degeneration after instrumented posterolateral lumbar fusion: a prospective cohort study with a minimum five-year follow-up

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

Abstract

Purpose

To (1) clarify the role of various risk factors in the development of ASD, (2) compare instrumentation configuration with the development of ASD, (3) correlate the radiological incidence of ASD and its clinical outcome and (4) compare the clinical outcome between patients with radiological evidence of ASD and without ASD.

Methods

This study prospectively examined 74 consecutive patients who underwent instrumented lumbar/lumbosacral fusion for degenerative disease with a minimum follow-up of 5 years. Among the patients, 68 were enrolled in the study. All of the patients had undergone preoperative radiological assessment and postoperative radiological assessment at regular intervals. The onset and progression of ASD changes were evaluated. The patients were divided in two groups: patients with radiographic evidence of ASD (group 1) and patients without ASD changes (group 2). Comprehensive analysis of various risk factors between group 1 and group 2 patients was performed. The Visual Analog Scale (VAS) was used to evaluate the clinical outcome and the functional outcome was evaluated using the Oswestry Disability Index (ODI) before and after surgery along with radiological assessment.

Results

Radiographic ASD occurred in 20.6% (14/68) of patients. Preoperative disc degeneration at an adjacent segment was a significant risk factor for ASD. Other risk factors such as the age of a patient at the time of surgery, gender, preoperative diagnosis, length of fusion, instrumentation configuration, sagittal alignment and lumbar or lumbosacral fusion were not significant risk factors for the development of ASD. There was no correlation between ASD and its clinical outcome as determined at the final follow-up session. In addition, clinical outcome of patients with ASD and without ASD were not comparable.

Conclusions

Patients with preoperative disc degeneration at an adjacent segment were more at risk for the development of ASD. Other risk factors including instrumentation configuration were not significantly associated with ASD. There was no correlation between both the radiological development of ASD and its clinical outcome and the clinical outcome of patients with and without ASD.

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
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ha KY, Schendel MJ, Lewis JL, Ogilvie JW (1993) Effect of immobilization and configuration on lumbar adjacent-segment biomechanics. J Spinal Disord 6:99–105

    Article  PubMed  CAS  Google Scholar 

  2. 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 (Phila Pa 1976) 18:2471–2479

    Article  CAS  Google Scholar 

  3. Quinnell RC, Stockdale HR (1981) Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Spine (Phila Pa 1976) 6:263–267

    Article  CAS  Google Scholar 

  4. Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE (2004) Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976) 29:1938–1944. doi:00007632-200409010-00019[pii]

    Article  Google Scholar 

  5. Aota Y, Kumano K, Hirabayashi S (1995) Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J Spinal Disord 8:464–473

    Article  PubMed  CAS  Google Scholar 

  6. Frymoyer JW, Hanley EN Jr, Howe J, Kuhlmann D, Matteri RE (1979) A comparison of radiographic findings in fusion and nonfusion patients ten or more years following lumbar disc surgery. Spine (Phila Pa 1976) 4:435–440

    Article  CAS  Google Scholar 

  7. Guigui P, Wodecki P, Bizot P, Lambert P, Chaumeil G, Deburge A (2000) Long-term influence of associated arthrodesis on adjacent segments in the treatment of lumbar stenosis: a series of 127 cases with 9-year follow-up. Rev Chir Orthop Reparatrice Appar Mot 86:546–557. MDOI-RCO-10-2000-86-6-0035-1040-101019-ART1[pii]

    PubMed  CAS  Google Scholar 

  8. 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  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  10. Throckmorton TW, Hilibrand AS, Mencio GA, Hodge A, Spengler DM (2003) The impact of adjacent level disc degeneration on health status outcomes following lumbar fusion. Spine (Phila Pa 1976) 28:2546–2550. doi:10.1097/01.BRS.0000092340.24070.F3

    Article  Google Scholar 

  11. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26:1873–1878

    Article  CAS  Google Scholar 

  12. Brodsky AE (1976) Post-laminectomy and post-fusion stenosis of the lumbar spine. Clin Orthop Relat Res 115:130–139

    PubMed  Google Scholar 

  13. Brodsky AE, Hendricks RL, Khalil MA, Darden BV, Brotzman TT (1989) Segmental (“floating”) lumbar spine fusions. Spine (Phila Pa 1976) 14:447–450

    Article  CAS  Google Scholar 

  14. Goldner JL (1981) The role of spine fusion. Question 6. Spine 6:293–303

    Article  Google Scholar 

  15. Hirabayashi K, Maruyama T, Wakano K, Ikeda K, Ishii Y (1981) Postoperative lumbar canal stenosis due to anterior spinal fusion. Keio J Med 30:133–139

    Article  PubMed  CAS  Google Scholar 

  16. Lee CK (1988) Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine (Phila Pa 1976) 13:375–377

    Article  CAS  Google Scholar 

  17. Cheh G, Bridwell KH, Lenke LG, Buchowski JM, Daubs MD, Kim Y, Baldus C (2007) Adjacent segment disease followinglumbar/thoracolumbar fusion with pedicle screw instrumentation: a minimum 5-year follow-up. Spine (Phila Pa 1976) 32:2253–2257. doi:10.1097/BRS.0b013e31814b2d8e00007632-200709150-00017[pii]

    Article  Google Scholar 

  18. Cole TC, Burkhardt D, Ghosh P, Ryan M, Taylor T (1985) Effects of spinal fusion on the proteoglycans of the canine intervertebral disc. J Orthop Res 3:277–291. doi:10.1002/jor.1100030304

    Article  PubMed  CAS  Google Scholar 

  19. Cole TC, Ghosh P, Hannan NJ, Taylor TK, Bellenger CR (1987) The response of the canine intervertebral disc to immobilization produced by spinal arthrodesis is dependent on constitutional factors. J Orthop Res 5:337–347. doi:10.1002/jor.1100050305

    Article  PubMed  CAS  Google Scholar 

  20. Lee CK, Langrana NA (1984) Lumbosacral spinal fusion. A biomechanical study. Spine (Phila Pa 1976) 9:574–581

    Article  CAS  Google Scholar 

  21. Axelsson P, Johnsson R, Stromqvist B (1997) The spondylolytic vertebra and its adjacent segment. Mobility measured before and after posterolateral fusion. Spine (Phila Pa 1976) 22:414–417

    Article  CAS  Google Scholar 

  22. Cunningham BW, Kotani Y, McNulty PS, Cappuccino A, McAfee PC (1997) The effect of spinal destabilization and instrumentation on lumbar intradiscal pressure: an in vitro biomechanical analysis. Spine (Phila Pa 1976) 22:2655–2663

    Article  CAS  Google Scholar 

  23. Dekutoski MB, Schendel MJ, Ogilvie JW, Olsewski JM, Wallace LJ, Lewis JL (1994) Comparison of in vivo and in vitro adjacent segment motion after lumbar fusion. Spine (Phila Pa 1976) 19:1745–1751

    Article  CAS  Google Scholar 

  24. 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

    PubMed  CAS  Google Scholar 

  25. Rahm MD, Hall BB (1996) Adjacent-segment degeneration after lumbar fusion with instrumentation: a retrospective study. J Spinal Disord 9:392–400

    Article  PubMed  CAS  Google Scholar 

  26. 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  PubMed  CAS  Google Scholar 

  27. Ha KY, Chang CH, Kim KW, Kim YS, Na KH, Lee JS (2005) Expression of estrogen receptor of the facet joints in degenerative spondylolisthesis. Spine (Phila Pa 1976) 30:562–566. doi:00007632-200503010-00015[pii]

    Article  Google Scholar 

  28. Hsu K, Zucherman J, White A (1993) The long term effect of lumbar spine fusion: Deterioration of adjacent motion segments. In: Yonenobu K, Ono K, Takemitsu Y (eds) Lumbar Fusion and Stabilization. Springer, Tokyo, pp 54–64

    Google Scholar 

  29. Panjabi MM, White AA 3rd (1980) Basic biomechanics of the spine. Neurosurgery 7:76–93

    Article  PubMed  CAS  Google Scholar 

  30. Chung KJ, Suh SW, Swapnil K, Yang JH, Song HR (2007) Facet joint violation during pedicle screw insertion: a cadaveric study of the adult lumbosacral spine comparing the two pedicle screw insertion techniques. Int Orthop 31:653–656. doi:10.1007/s00264-006-0249-x

    Article  PubMed  Google Scholar 

  31. Chen WJ, Lai PL, Niu CC, Chen LH, Fu TS, Wong CB (2001) Surgical treatment of adjacent instability after lumbar spine fusion. Spine (Phila Pa 1976) 26:E519–E524

    Article  CAS  Google Scholar 

  32. Chow DH, Luk KD, Evans JH, Leong JC (1996) Effects of short anterior lumbar interbody fusion on biomechanics of neighboring unfused segments. Spine (Phila Pa 1976) 21:549–555

    Article  CAS  Google Scholar 

  33. Moskowitz A, Moe JH, Winter RB, Binner H (1980) Long-term follow-up of scoliosis fusion. J Bone Joint Surg Am 62:364–376

    PubMed  CAS  Google Scholar 

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

    PubMed  Google Scholar 

  35. Nakai S, Yoshizawa H, Kobayashi S (1999) Long-term follow-up study of posterior lumbar interbody fusion. J Spinal Disord 12:293–299

    Article  PubMed  CAS  Google Scholar 

  36. Djurasovic MO, Carreon LY, Glassman SD, Dimar JR 2nd, Puno RM, Johnson JR (2008) Sagittal alignment as a risk factor for adjacent level degeneration: a case-control study. Orthopedics 31:546. orthosupersite.com/view.asp?rID=28248[pii]orthopedics.28248[pii]

    Article  PubMed  Google Scholar 

  37. Cochran T, Irstam L, Nachemson A (1983) Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion. Spine (Phila Pa 1976) 8:576–584

    Article  CAS  Google Scholar 

  38. Ha KY, Lee JS, Kim KW (2008) Degeneration of sacroiliac joint after instrumented lumbar or lumbosacral fusion: a prospective cohort study over five-year follow-up. Spine (Phila Pa 1976) 33:1192–1198. doi:10.1097/BRS.0b013e318170fd3500007632-200805150-00007[pii]

    Article  Google Scholar 

  39. Ishihara H, Osada R, Kanamori M, Kawaguchi Y, Ohmori K, Kimura T, Matsui H, Tsuji H (2001) Minimum 10-year follow-up study of anterior lumbar interbody fusion for isthmic spondylolisthesis. J Spinal Disord 14:91–99

    Article  PubMed  CAS  Google Scholar 

  40. 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 (Phila Pa 1976) 25:1837–1842

    Article  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Ku, Seoul, 137 040, Korea

    Jigar Anandjiwala, Kee-Yong Ha, In-Soo Oh & Dong-Cheul Shin

  2. Department of Orthopedic Surgery, Jeju National University Hospital, School of Medicine, Jeju National University, Jeju, Korea

    Jun-Yeong Seo

Authors
  1. Jigar Anandjiwala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jun-Yeong Seo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kee-Yong Ha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. In-Soo Oh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dong-Cheul Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kee-Yong Ha.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Anandjiwala, J., Seo, JY., Ha, KY. et al. Adjacent segment degeneration after instrumented posterolateral lumbar fusion: a prospective cohort study with a minimum five-year follow-up. Eur Spine J 20, 1951–1960 (2011). https://doi.org/10.1007/s00586-011-1917-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-011-1917-0

Keywords

Search

Navigation