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Adjacent segment disk degeneration three decades after fusion without attempted reduction for high-grade isthmic spondylolisthesis

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Abstract

Study design

Observational study.

Objectives

To evaluate adjacent segment disk degeneration (ASD) after fusion without attempted reduction at a young age for high-grade isthmic spondylolisthesis.

Summary of background data

The clinical relevance of ASD remains unclear. Previous studies have shown that spinal fusion is associated with increased ASD but without influence on clinical outcome. Since high-grade spondylolisthesis is a severe kyphotic deformity, one could hypothesize that fusion without attempted reduction in young patients leads to accelerated adjacent segment disk degeneration in adult life.

Methods

Anterior and posterior disk heights were evaluated on supine radiographs of the spine 8 years and 29 years after fusion without attempted reduction for high-grade spondylolisthesis and also on standing radiographs 8 years and 33 years after surgery. Pelvic parameters were evaluated on standing radiographs obtained 33 years after surgery. Health-related quality of life was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire.

Results

One segment above fusion the anterior disk height significantly decreased on standing radiographs. Two segments above the fusion, the anterior disk height significantly decreased on supine as well as on standing radiographs. The largest reduction was found two segments above the fusion where the disk height was reduced from 33 to 28% of anterior vertebral height between the measurements at mean 8 years and mean 33 years after surgery. There were no statistically significant decreases in posterior disk heights in any measurement. The disk height showed a moderate negative correlation to PT. There was no correlation between disk height reduction and SRS-22r outcome.

Conclusions

In our long-term follow-up of fusion without attempted reduction for high-grade spondylolisthesis in young patients, we found only a minor but statistically significant reduction in adjacent segment disk height which had no apparent impact on clinical outcome.

Level of evidence

Level IV.

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Funding

No funding was received for this work.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Orebro University School of Medical Sciences, Orebro University Hospital, 701 85, Orebro, Sweden

    Anders Joelson & Per Wretenberg

  2. Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, 413 45, Gothenburg, Sweden

    Barbro I. Danielson

  3. Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, 413 45, Gothenburg, Sweden

    Rune Hedlund & Karin Frennered

Authors
  1. Anders Joelson
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  2. Barbro I. Danielson
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  3. Rune Hedlund
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  4. Per Wretenberg
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  5. Karin Frennered
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Contributions

AJ: Conception of the work, analysis and interpretation of data for the work, drafting the manuscript, revising the manuscript, final approval of the manuscript. BID: Conception of the work, acquisition and interpretation of data for the work, revising the manuscript, final approval of the manuscript. RH: Conception of the work, interpretation of data for the work, revising the manuscript, final approval of the manuscript. PW: Conception of the work, interpretation of data for the work, revising the manuscript, final approval of the manuscript. KF: Conception of the work, interpretation of data for the work, revising the manuscript, final approval of the manuscript.

Corresponding author

Correspondence to Anders Joelson.

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Conflict of interest

The authors declare that there is no conflict of interests.

Ethical approval

The study was approved by the regional ethical review board in Gothenburg, Registration Number 640-08 and T975-15.

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Joelson, A., Danielson, B.I., Hedlund, R. et al. Adjacent segment disk degeneration three decades after fusion without attempted reduction for high-grade isthmic spondylolisthesis. Spine Deform 8, 743–750 (2020). https://doi.org/10.1007/s43390-020-00085-6

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  • DOI: https://doi.org/10.1007/s43390-020-00085-6

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