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Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360° fusion

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Abstract

Adjacent segment degeneration (ASD) is discussed to impair long-term outcome after lumbar interbody fusion. Nevertheless the amount and origin of degeneration and its clinical relevance remain unclear. Only little data is published studying quantitative disc height reduction (DHR) as indicator for ASD in long-term follow-up. Forty patients (23 men, 17 women) (group 1: degenerative disc disease, n = 27; group 2: lytic spondylolisthesis, n = 13) underwent lumbar 360° instrumentation and fusion between 1991 and 1997. Preoperative and follow-up lateral lumbar radiographs were studied. Disc heights of first and second cephalad adjacent segments were measured by Farfan’s technique and Hurxthal’s technique modified by Pope. Clinical outcome was studied using Oswestry disability index (ODI) and visual analogue scale (VAS). Age, gender, prior surgery, fusion rate and number of fusion levels were investigated as potential factors affecting the outcome. Mean follow-up was 114 (72–161) months. Clinical outcome showed an improvement of 44.6% in ODI and 43.8% in VAS with a tendency towards better results in group 2. Fusion rate was 95%. Disc height of the first cephalad adjacent segment in all patients was reduced by on average 21% (Farfan, P < 0.001) and 19% (Pope, P < 0.001), respectively, and that of the second adjacent level by on average 16% (Farfan, P < 0.001) and 14% (Pope, P < 0.001), respectively. A tendency towards more disc height reduction (DHR) in the degenerative group was observed. Advanced age correlated with advanced DHR (P ≤ 0.003, r = 0.5). Multiple level fusion led to a more pronounced DHR than 1-level fusion (P = 0.028). There was a tendency towards more DHR in the first adjacent disc compared to the second. Gender, prior surgery of the fused segment and fusion level did not affect the amount of DHR. There was no correlation between the clinical outcome and DHR. Lumbar fusion is associated with DHR of adjacent discs. This may be induced by additional biomechanical stress, ongoing degeneration affecting the lumbar spine and advancing age. However, clinical outcome is not correlated with adjacent DHR.

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Authors and Affiliations

  1. Department of Orthopaedics, University Hospital Münster, Albert-Schweitzer-Strasse 33, 48149, Münster, Germany

    Tobias L. Schulte, Freek Leistra, Viola Bullmann, Björn Marquardt, Thomas Lerner, Ulf Liljenqvist & Lars Hackenberg

  2. Department of Medical Informatics and Biomathematics, University of Münster, Domagkstrasse 9, 48149, Münster, Germany

    Nani Osada

  3. Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Strasse 33, 48149, Münster, Germany

    Volker Vieth

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  1. Tobias L. Schulte
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  2. Freek Leistra
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Correspondence to Tobias L. Schulte.

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The submitted manuscript does not contain information about drugs. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article. The experiments comply with the current laws of Germany. Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Schulte, T.L., Leistra, F., Bullmann, V. et al. Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360° fusion. Eur Spine J 16, 2152–2158 (2007). https://doi.org/10.1007/s00586-007-0515-7

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  • DOI: https://doi.org/10.1007/s00586-007-0515-7

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