Adjacent segment degeneration after lumbar spinal fusion compared with motion-preservation procedures: a meta-analysis

Abstract

Purpose

This meta-analysis aimed to evaluate the efficacy of motion-preservation procedures to prevent the adjacent segment degeneration (ASDeg) or adjacent segment disease (ASDis) compared with fusion in lumbar spine.

Methods

PubMed, Embase and the Cochrane Library were comprehensively searched and a meta-analysis was performed of all randomized controlled trials and well designed prospective or retrospective comparative cohort studies assessing the lumbar fusion and motion-preservation procedures. We compared the ASDeg and ASDis rate, reoperation rate, operation time, blood loss, length of hospital stay, visual analogue scale (VAS) and oswestry disability index (ODI) improvement of the two procedures.

Results

A total of 15 studies consisting of 1474 patients were included in this study. The meta-analysis indicated that the prevalence of ASDeg, ASDis and reoperation rate on the adjacent level were lower in motion-preservation procedures group than in the fusion group (P = 0.001; P = 0.0004; P < 0.0001). Moreover, shorter length of hospital stay was found in motion-preservation procedures group (P < 0.0001). No difference was found in terms of operation time (P = 0.57), blood loss (P = 0.27), VAS (P = 0.76) and ODI improvement (P = 0.71) between the two groups.

Conclusions

The present evidences indicated that the motion-preservation procedures had an advantage on reducing the prevalence of ASDeg, ASDis and the reoperation rate due to the adjacent segment degeneration compared with the lumbar fusion. And the clinical outcomes of the two procedures are similar.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

References

  1. 1.

    Bono CM, Lee CK (2004) Critical analysis of trends in fusion for degenerative disc disease over the past 20 years: influence of technique on fusion rate and clinical outcome. Spine 29:455–463

  2. 2.

    Omair A, Mannion AF, Holden M, Leivseth G, Fairbank J, Hägg O, Fritzell P, Brox JI (2015) Age and pro-inflammatory gene polymorphisms influence adjacent segment disc degeneration more than fusion does in patients treated for chronic low back pain. Eur Spine J 25(1):2–13

    Article  PubMed  Google Scholar 

  3. 3.

    Radcliff KE, Kepler CK, Jakoi A, Sidhu GS, Rihn J, Vaccaro AR, Albert TJ, Hilibrand AS (2013) Adjacent segment disease in the lumbar spine following different treatment interventions. Spine J 13:1339–1349

    Article  PubMed  Google Scholar 

  4. 4.

    Schmoelz W, Huber JF, Nydegger T, Dipl-Ing, Claes L, Wilke HJ (2003) Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment. J Spinal Disord Tech 16:418–423

  5. 5.

    Khoueir P, Kim KA, Wang MY (2007) Classification of posterior dynamic stabilization devices. Neurosurg Focus 22:E3

    PubMed  Google Scholar 

  6. 6.

    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 33:1701–1707

    Article  PubMed  Google Scholar 

  7. 7.

    Wang JC, Arnold PM, Hermsmeyer JT, Norvell DC (2012) Do lumbar motion preserving devices reduce: the risk of adjacent segment pathology compared with fusion surgery? Spine 37:133–143

    Article  Google Scholar 

  8. 8.

    Lu K, Liliang PC, Wang HK, Liang CL, Chen JS, Chen TB, Wang KW, Chen HJ (2015) Reduction in adjacent-segment degeneration after multilevel posterior lumbar interbody fusion with proximal DIAM implantation. J Neurosurg Spine 23(2):190–196

    Article  PubMed  Google Scholar 

  9. 9.

    Yang Y, Hong Y, Liu H, Song Y, Li T, Liu L, Gong Q (2015) Comparison of clinical and radiographic results between isobar posterior dynamic stabilization and posterior lumbar inter-body fusion for lumbar degenerative disease: a four-year retrospective study. Clin Neurol Neurosurg 136:100–106

    Article  PubMed  Google Scholar 

  10. 10.

    Cota GF, de Sousa MR, Fereguetti TO, Rabello A (2013) Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis 7:e2195

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Olsen JJ, Skov J, Ingerslev J, Thorn JJ, Pinholt EM (2015) Prevention of bleeding in orthognathic surgery—a systematic review and meta-analysis of randomized controlled trials. J Oral Maxillofac Surg

  12. 12.

    Kanayama M, Hashimoto T, Shigenobu K, Harada M, Oha F, Ohkoshi Y, Tada H, Yamamoto K, Yamane S (2001) Adjacent-segment morbidity after Graf ligamentoplasty compared with posterolateral lumbar fusion. J Neurosurg 95(1 Suppl):5–10

    CAS  PubMed  Google Scholar 

  13. 13.

    Kumar A, Beastall J, Hughes J, Karadimas EJ, Nicol M, Smith F, Wardlaw D (2008) Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after two years. Spine (Phila Pa 1976) 33:2909–2914

  14. 14.

    Korovessis P, Repantis T, Zacharatos S, Zafiropoulos A (2009) Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion? Eur Spine J 18:830–840

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Azzazi A, Elhawary Y (2010) Dynamic stabilization using x-stop versus transpedicular screw fixation in the treatment of lumbar canal stenosis: comparative study of the clinical outcome. Neurosurg Q 20:165–169

    Article  Google Scholar 

  16. 16.

    Yu SW, Yang SC, Ma CH, Wu CH, Yen CY, Tu YK (2012) Comparison of Dynesys posterior stabilization and posterior lumbar interbody fusion for spinal stenosis L4L5. Acta Orthop Belg 78:230–239

    PubMed  Google Scholar 

  17. 17.

    Yu SW, Yen CY, Wu CH, Kao FC, Kao YH, Tu YK (2012) Radiographic and clinical results of posterior dynamic stabilization for the treatment of multisegment degenerative disc disease with a minimum follow-up of 3 years. Arch Orthop Trauma Surg 132:583–589

    Article  PubMed  Google Scholar 

  18. 18.

    Lee CH, Hyun SJ, Kim KJ, Jahng TA, Yoon SH, Kim HJ (2013) The efficacy of lumbar hybrid stabilization using the DIAM™ to delay adjacent segment degeneration: an intervention comparison study with a minimum two-year follow-up. Neurosurgery 73(2 Suppl Operative):ons224–231

    PubMed  Google Scholar 

  19. 19.

    Berg S, Tullberg T, Branth B, Olerud C, Tropp H (2009) Total disc replacement compared to lumbar fusion: a randomised controlled trial with 2-year follow-up. Eur Spine J 18(10):1512–1519

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Guyer RD, McAfee PC, Banco RJ, Bitan FD, Cappuccino A, Geisler FH, Hochschuler SH, Holt RT, Jenis LG, Majd ME, Regan JJ, Tromanhauser SG, Wong DC, Blumenthal SL (2009) Prospective, randomized, multicenter food and drug administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: five-year follow-up. Spine J 9:374–386

    Article  PubMed  Google Scholar 

  21. 21.

    Kanayama M, Togawa D, Hashimoto T, Shigenobu K, Oha F (2009) Motion-preserving surgery can prevent early breakdown of adjacent segments: comparison of posterior dynamic stabilization with spinal fusion. J Spinal Disord Tech 22:463–467

    Article  PubMed  Google Scholar 

  22. 22.

    Kaner T, Dalbayrak S, Oktenoglu T, Sasani M, Aydin AL, Ozer AF (2010) Comparison of posterior dynamic and posterior rigid transpedicular stabilization with fusion to treat degenerative spondylolisthesis. Orthopedics 33:1433–1434

  23. 23.

    Putzier M, Hoff E, Tohtz S, Gross C, Perka C, Strube P (2010) Dynamic stabilization adjacent to single-level fusion: part II. No clinical benefit for asymptomatic, initially degenerated adjacent segments after 6 years follow-up. Eur Spine J 19:2181–2189

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    McAfee PC, Geisler FH, Saiedy SS, Moore SV, Regan JJ, Guyer RD, Blumenthal SL, Fedder IL, Tortolani PJ, Cunningham B (2006) Revisability of the CHARITE artificial disc replacement: analysis of 688 patients enrolled in the US IDE study of the CHARITE Artificial Disc. Spine (Phila Pa 1976) 31:1217–1226

  25. 25.

    Lawrence BD, Wang J, Arnold PM, Hermsmeyer J, Norvell DC, Brodke DS (2012) Predicting the risk of adjacent segment pathology after lumbar fusion: a systematic review. Spine (Phila Pa 1976) 37(22 Suppl):123–132

  26. 26.

    Lund T, Oxland TR (2011) Adjacent level disk disease—is it really a fusion disease? Orthop Clin North Am 42:529–541

    Article  PubMed  Google Scholar 

  27. 27.

    Wai EK, Santos ER, Morcom RA, Fraser RD (2006) Magnetic resonance imaging 20 years after anterior lumbar interbody fusion. Spine (Phila Pa 1976) 31:1952–1956

  28. 28.

    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

  29. 29.

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

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Booth KC, Bridwell KH, Eisenberg BA, Baldus CR, Lenke LG (1999) Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion. Spine (Phila Pa 1976) 24:1721–1727

  31. 31.

    Hambly MF, Wiltse LL, Raghavan N, Schneiderman G, Koenig C (1998) The transition zone above a lumbosacral fusion. Spine (Phila Pa 1976) 23:1785–1792

  32. 32.

    Kumar MN, Jacquot F, Hall HN (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

  33. 33.

    Grob D, Benini A, Junge A, Mannion AF (2005) Clinical experience with the Dynesys semirigid fixation system for the lumbar spine: surgical and patient-oriented outcome in 50 cases after an average of 2 years. Spine (Phila Pa 1976) 30:324–331

  34. 34.

    Korovessis P, Papazisis Z, Koureas G, Lambiris E (2004) Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis: a correlative radiological and clinical analysis of short-term results. Spine (Phila Pa 1976) 29:735–742

  35. 35.

    Grevitt MP, Gardner AD, Spilsbury J, Shackleford IM, Baskerville R, Pursell LM, Hassaan A, Mulholland RC (1995) The Graf stabilisation system: early results in 50 patients. Eur Spine J 4:169–175

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Rainey S, Blumenthal SL, Zigler JE, Guyer RD, Ohnmeiss DD (2012) Analysis of adjacent segment reoperation after lumbar total disc replacement. Int J Spine Surg 6:140–144

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Zhu Z, Liu C, Wang K, Zhou J, Wang J, Zhu Y, Liu H (2015) Topping-off technique prevents aggravation of degeneration of adjacent segment fusion revealed by retrospective and finite element biomechanical analysis. J Orthop Surg Res 10:10

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Lu S, Kong C, Hai Y, Wang Q, Zang L, Kang N, Meng X, Wang Y (2015) Retrospective study on effectiveness of activ L total disc replacement: clinical and radiographical results of 1- to 3-year follow-up. Spine (Phila Pa 1976) 40:411–417

  39. 39.

    Büttner-Janz K, Guyer RD, Ohnmeiss DD (2014) Indications for lumbar total disc replacement: selecting the right patient with the right indication for the right total disc. Int J Spine Surg 8:1

  40. 40.

    Adelt D (2010) The interspinous U implant (now Coflex): long-term outcome, study overview and differential indication. Orthopade 39:595–601

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Andersen T, Videbaek TS, Hansen ES, Bünger C, Christensen FB (2008) The positive effect of posterolateral lumbar spinal fusion is preserved at long-term follow-up: a RCT with 11–13 year follow-up. Eur Spine J 17:272–280

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Lee SE, Park SB, Jahng TA, Chung CK, Kim HJ (2008) Clinical experience of the dynamic stabilization system for the degenerative spine disease. J Korean Neurosurg Soc 43:221–226

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Putzier M, Schneider SV, Funk JF, Tohtz SW, Perka C (2005) The surgical treatment of the lumbar disc prolapse: nucleotomy with additional transpedicular dynamic stabilization versus nucleotomy alone. Spine (Phila Pa 1976) 30:E109–E114

  44. 44.

    Nockels RP (2005) Dynamic stabilization in the surgical management of painful lumbar spinal disorders. Spine (Phila Pa 1976) 30(16 Suppl):68–72

  45. 45.

    Brechbühler D, Markwalder TM, Braun M (1998) Surgical results after soft system stabilization of the lumbar spine in degenerative disc disease–long-term results. Acta Neurochir (Wien) 140:521–525

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Yong Hai.

Ethics declarations

Conflict of interest

None of the authors has any potential conflict of interest. No funds were received in support of this work. No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subject of this manuscript.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Pan, A., Hai, Y., Yang, J. et al. Adjacent segment degeneration after lumbar spinal fusion compared with motion-preservation procedures: a meta-analysis. Eur Spine J 25, 1522–1532 (2016). https://doi.org/10.1007/s00586-016-4415-6

Download citation

Keywords

  • Adjacent segment degeneration
  • Adjacent segment disease
  • Lumbar spinal fusion
  • Motion-preservation procedures
  • Meta-analysis