Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-07-2014 | Original Article

Adjacent segment degeneration and disease after lumbar fusion compared with motion-preserving procedures: a meta-analysis

Authors: Chunpeng Ren, Yueming Song, Limin Liu, Youdi Xue

Published in: European Journal of Orthopaedic Surgery & Traumatology | Special Issue 1/2014

Abstract

Purpose

The purpose of our study was to compare lumbar fusion and motion-preserving procedures to determine whether lumbar fusion may be associated with a higher prevalence of adjacent segment degeneration (ASDeg) or adjacent segment disease (ASDis).

Methods

We performed a systematic review and meta-analysis for articles published up to July 2013. We included randomized controlled trials and cohort studies that reported ASDeg or ASDis after lumbar fusion compared with motion-preserving devices. Two authors independently extracted the articles and the predefined data.

Results

A total of 13 studies with 1,270 patients met our inclusion criteria and were included in the final analysis. Our analysis showed that the prevalence of ASDeg and ASDis, and adjacent segment reoperation rate in the fusion group were higher than those in the motion-preserving devices group (P < 0.0001, P = 0.0008, and P < 0.0001, respectively). The prevalence of ASDeg and reoperation rate in the motion-preserving devices group were significantly lower than that in the fusion group for both short- and long-term follow-up (P = 0.0008 and P = 0.001 at <5 years of follow-up; P = 0.003 and P = 0.001 at >5 years of follow-up).

Conclusions

The current evidence suggests that lumbar fusion may result in a higher prevalence of adjacent segment degeneration or disease than motion-preserving procedures.

Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4(Suppl):190S–194S. doi:10.1016/j.spinee.2004.07.007 PubMedCrossRef

Harrop JS, Youssef JA, Maltenfort M, Vorwald P, Jabbour P, Bono CM (2008) Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine 33:1701–1707PubMedCrossRef

Yang BH, Li HP, Zhang T, He XJ, Xu SY (2012) The incidence of adjacent segment degeneration after cervical disc arthroplasty (CDA): a meta-analysis of randomized controlled trials. PLoS ONE 7(4):e35032. doi:10.1371/journal.pone.0035032 PubMedCentralPubMedCrossRef

Botelho RV, Moraes OJ, Fernandes GA, Buscariolli YD, Bernardo WM (2010) A systematic review of randomized trials on the effect of cervical disc arthroplasty on reducing adjacent-level degeneration. Neurosurg Focus 28:E5. doi:10.3171/2010.3.FOCUS1032 PubMedCrossRef

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:S133–S143. doi:10.1097/BRS.0b013e31826cadf2 PubMedCrossRef

Higgins JP, Altman DG, Gotzsche PC (2011) The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. doi:10.1136/bmj.d5928 PubMedCentralPubMedCrossRef

Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2012) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 10 Oct 2012

Deeks JJ, Higgins JPT, Altman DG (editors) (2011) Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www. cochrane-handbook.org. ed: The Cochrane Collaboration

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 Publish Ahead of Print 5 March 2013 doi:10.1227/NEU.0b013e31828e8ddc

10.

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 78:230–239PubMed

11.

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 multi-segment degenerative disc disease with a minimum follow-up of 3 years. Arch Orthop Trauma Surg 132:583–589. doi:10.1007/s00402-012-1460-4 PubMedCrossRef

12.

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. doi:10.1097/WNQ.0b013e3181ebb0ea CrossRef

13.

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. doi:10.1007/s00586-010-1517-4 PubMedCentralPubMedCrossRef

14.

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(5):309. doi:10.3928/01477447-20100329-09

15.

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 J18:1512–1519. doi:10.1007/s00586-009-1047-0 CrossRef

16.

Guyer RD, McAfee PC, Banco RJ, Bitan FD, Cappuccino A, Geisler FH (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. doi:10.1016/j.spinee.2008.08.007 PubMedCrossRef

17.

Kanayama M, Togawa D, Hashimoto T, Shigenobu K, Oha F (2009) Motion-preserving surgery can prevent early breakdown of adjacent segments. J Spinal Disord Tech 22(7):243–247. doi:10.1097/BSD.0b013e3181934512 CrossRef

18.

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. doi:10.1007/s00586-009-0976-y PubMedCentralPubMedCrossRef

19.

Kumar A, Beastall J, Hughes J, Karadimas EJ, Nicol M, Smith F (2008) Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after 2 years. Spine 33:2909–2914. doi:10.1097/BRS.0b013e31818bdca7 PubMedCrossRef

20.

McAfee PC, Geisler FH, Saiedy SS, Moore SV, Regan JJ, Guyer RD (2006) Revisability of the CHARITE´ artificial disc replacement analysis of 688 patients enrolled in the U.S. IDE study of the CHARITE artificial disc. Spine 31(11):1217–1226. doi:10.1097/01.brs.0000217689.08487.a8 PubMedCrossRef

21.

Kanayama M, Hashimoto T, Shigenobu K, Harada M, Oha F, Ohkoshi Y (2001) Adjacent-segment morbidity after Graf ligamentoplasty compared with posterolateral lumbar fusion. J Neurosurg 95S:5–10. doi:10.3171/spi.2001.95.1.0005

22.

Booth KC, Bridwell KH, Eisenberg BA et al (1999) Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion. Spine 24:1721–1727. doi:10.1097/00007632-199908150-00014 PubMedCrossRef

23.

Hambly MF, Wiltse LL, Raghavan N, Schneiderman G, Koenig C (1998) The transition zone above a lumbosacral fusion. Spine 23:1785–1792. doi:10.1097/00007632-199808150-00012 PubMedCrossRef

24.

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. doi:10.1007/s005860000239 PubMedCentralPubMedCrossRef

25.

Wai EK, Santos ER, Morcom RA, Fraser RD (2006) Magnetic resonance imaging 20 years after anterior lumbar interbody fusion. Spine (Phila Pa 1976) 31(17): 1952–1956. doi:10.1097/01.brs.0000228849.37321.a8

26.

Lee MJ, Dettori JR, Standaert CJ, Ely CG, Chapman JR (2012) Indication for spinal fusion and the risk of adjacent segment pathology: does reason for fusion affect risk? A systematic review. Spine 37:S40–S51. doi:10.1097/BRS.0b013e31826ca9b1 PubMedCrossRef

27.

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. doi:10.1007/s005860000207 PubMedCentralPubMedCrossRef

28.

Gillet P (2003) The fate of the adjacent motion segments after lumbar fusion. J Spinal Disord Tech 16:338–345PubMedCrossRef

29.

Umehara S, Zindrick MR, Patwardhan AG, Havey RM, Vrbos LA, Knight GW et al (2000) The biomechanical effect of postoperative hyperlordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine 25:1617–1624. doi:10.1097/00007632-200007010-00004 PubMedCrossRef

30.

Xia XP, Chen HL, Cheng HB (2013) Prevalence of adjacent segment degeneration after spine surgery. A systematic review and meta-analysis. Spine 38:597–608. doi:10.1097/BRS.0b013e318273a2ea PubMedCrossRef

31.

Lee CS, Hwang CJ, Lee SW, Ahn YJ, Kim YT, Lee DH (2009) Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J 18:1637–1643. doi:10.1007/s00586-009-1060-3 PubMedCentralPubMedCrossRef

32.

Huang RC, Tropiano P, Marnay T, Girardi FP, Lim MR, Cammisa FP (2006) Range of motion and adjacent level degeneration after lumbar total disc replacement. Spine J 6:242–247. doi:10.1016/j.spinee.2005.04.013 PubMedCrossRef

33.

Meir AR, Brian JC, Freeman MB, Bao B, Fraser RD, Fowler SM (2013) Ten-year survival and clinical outcome of the AcroFlex lumbar disc replacement for the treatment of symptomatic disc degeneration. Spine J 13:13–21. doi:10.1016/j.spinee.2012.12.008 PubMedCrossRef

34.

Schaeren S, Broger I, Jeanneret B (2008) Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine 33:E636–E642. doi:10.1097/BRS.0b013e31817d2435 PubMedCrossRef

35.

Li ZH, Li FN, Yu SZ, Ma H, Chen ZH, Zhang HL (2013) Two-year follow-up results of the Isobar TTL semi-rigid rod system for the treatment of lumbar degenerative disease. J Clin Neurosci 20:394–399. doi:10.1016/j.jocn.2012.02.043 PubMedCrossRef

36.

Heo DH, Cho YJ, Cho SM, Choi HC, Kang SH (2012) Adjacent segment degeneration after lumbar dynamic stabilization using pedicle screws and a nitinol spring rod system with 2-year minimum follow-up. J Spinal Disord Tech 25:409–414. doi:10.1097/BSD.0b013e318231665d PubMedCrossRef

37.

Goto K, Tajima N, Chosa E, Totoribe K, Kubo S, Kuroki H, Arai T (2003) Effects of lumbar spinal fusion on the other lumbar intervertebral levels (three-dimensional finite element analysis). J Orthop Sci 8:577–584. doi:10.1007/s00776-003-0675-1 PubMedCrossRef

38.

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

39.

Lee CK (1988) Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine 13:375–377. doi:10.1097/00007632-198803000-00029 PubMedCrossRef

40.

Weinhoffer SL, Guyer RD, Herbert M, Griffith SL (1995) Intradiscal pressure measurements above an instrumented fusion: a cadaveric study. Spine 20:526–531. doi:10.1097/00007632-199503010-00004 PubMedCrossRef

41.

Min JH, Jang JS, Jung B, Lee HY, Choi WC, Shim CS et al (2008) The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion. J Spinal Disord Tech 21(5):305–309. doi:10.1097/BSD.0b013e318142b960 PubMedCrossRef

42.

Disch AC, Schmoelz W, Matziolis G, Schneider SV, Knop C, Putzier M (2008) Higher risk of adjacent segment degeneration after floating fusions: long-term outcome after low lumbar spine fusions. J Spinal Disord Tech 21(2):79–85. doi:10.1097/BSD.0b013e3180577259 PubMedCrossRef

43.

Richards JC, Majumdar S, Lindsey DP, Beaupre GS, Yerby SA (2005) The treatment mechanism of an interspinous process implant for lumbar neurogenic intermittent claudication. Spine 30:744–749. doi:10.1097/01.brs.0000157483.28505.e3 PubMedCrossRef

44.

Sears WR, Sergides IG, Kazemi N, Smith M, White GJ, Osburg B (2011) Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis. Spine J 11:11–20. doi:10.1016/j.spinee.2010.09.026 PubMedCrossRef

45.

Andersen T, Videbaek TS, Hansen ES, Bunger 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. doi:10.1007/s00586-007-0494-8 PubMedCentralPubMedCrossRef

46.

Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C (1993) The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 6:461–472PubMedCrossRef

47.

Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson ANA et al (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91:1295–1304. doi:10.2106/JBJS.H.00913 PubMedCentralPubMedCrossRef

48.

Sengupta DK, Herkowitz HN (2005) Degenerative spondylolisthesis: review of current trends and controversies. Spine (Phila Pa 1976) 30:S71–S81 doi:10.1097/01.brs.0000155579.88537.8e

49.

Bordes-Monmeneu M, Bordes-Garcia V, Rodrigo-Baeza F, Saez D (2005) System of dynamic neutralization in the lumbar spine: experience on 94 cases. (in Spanish). Neurocirugia 16:499–506PubMed

50.

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. doi:10.3340/jkns.2008.43.5.221 PubMedCentralPubMedCrossRef

51.

Nockels RP (2005) Dynamic stabilization in the surgical management of painful lumbar spinal disorders. Spine 30(16 Suppl):S68–S72. doi:10.1097/01.brs.0000174531.19982.99 PubMedCrossRef

52.

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 30:E109–E114. doi:10.1097/01.brs.0000154630.79887.ef PubMedCrossRef

53.

Grevitt MP, Gardner AD, Spilsbury J, Shackleford IM, Baskerville R, Pursell LM et al (1995) The Graf stabilisation system: early results in 50 patients. Eur Spine J 4:169–175. doi:10.1007/BF00298241 PubMedCrossRef

54.

Schnake KJ, Schaeren S, Jeanneret B (2006) Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine 31:442–449. doi:10.1097/01.brs.0000200092.49001.6e PubMedCrossRef

Title: Adjacent segment degeneration and disease after lumbar fusion compared with motion-preserving procedures: a meta-analysis
Authors: Chunpeng Ren
Yueming Song
Limin Liu
Youdi Xue
Publication date: 01-07-2014
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue Special Issue 1/2014
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-014-1445-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Adjacent segment degeneration and disease after lumbar fusion compared with motion-preserving procedures: a meta-analysis

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Special Issue 1/2014

A retrospective study of treating thoracolumbar spine fractures in ankylosing spondylitis

Current use of methylprednisolone for acute spinal cord injury in Poland: survey study

Does curve convexity affect the surgical outcomes of thoracic adolescent idiopathic scoliosis?

Effectiveness of three types of lumbar orthosis for restricting extension motion

Extracellular matrix-coating pedicle screws conduct and induce osteogenesis

PEEK rod systems for the spine