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Clinical Orthopaedics and Related Research®

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01-06-2014 | Symposium: Minimally Invasive Spine Surgery

Changes in the Adjacent Segment 10 Years After Anterior Lumbar Interbody Fusion for Low-Grade Isthmic Spondylolisthesis

Authors: Kyung-Chul Choi, MD, PhD, Jin-Sung Kim, MD, PhD, Hyeong-Ki Shim, MD, Yong Ahn, MD, PhD, Sang-Ho Lee, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2014

Abstract

Background

Adjacent segment degeneration is a long-term complication of arthrodesis. However, the incidence of adjacent segment degeneration varies widely depending on the patient’s age and underlying disease and the fusion techniques and diagnostic methods used.

Questions/purposes

We determined (1) the frequency of adjacent segment degeneration and increased lordosis on imaging tests, (2) the frequency and severity of clinical sequelae of these findings, including revision surgery, and (3) the sequence of degeneration and risk factors for degeneration.

Methods

Seventy-three patients underwent anterior lumbar interbody fusion for low-grade isthmic spondylolisthesis at one institution between October 2000 and February 2002. Forty-nine (67%) of the original patients had complete radiographic and clinical followup for 10 years. CT and MRI were performed at 5 years and 10 years in all cases. The disc height, sagittal profiles, and facet and disc degeneration at adjacent levels were examined to identify radiographic and clinical adjacent segment degeneration. Mean followup was 134.2 months (range, 120–148 months).

Results

Cranial segment lordosis increased (from 14.8° to 18.5°; p < 0.001), while caudal segment lordosis changed little (from 16.4° to 17.3°). Radiographic and clinical adjacent segment degeneration occurred in 19 (38.8%) and six (12.2%) patients, respectively, and two patients (4.1%) underwent revision surgery. Patients with adjacent segment degeneration had more advanced preexisting facet degeneration than patients without adjacent segment degeneration (odds ratio: 18.6; 95% CI, 1.97–175.54, p = 0.01). Acceleration of disc and facet degeneration occurred in 4.1% and 10.2%, respectively.

Conclusions

Adjacent segment degeneration requiring surgery is rare, although radiographic adjacent segment degeneration is common after anterior lumbar interbody fusion for isthmic spondylolisthesis. The only risk factor we found was preexisting facet degeneration of the cranial segment.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence

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Title: Changes in the Adjacent Segment 10 Years After Anterior Lumbar Interbody Fusion for Low-Grade Isthmic Spondylolisthesis
Authors: Kyung-Chul Choi, MD, PhD
Jin-Sung Kim, MD, PhD
Hyeong-Ki Shim, MD
Yong Ahn, MD, PhD
Sang-Ho Lee, MD, PhD
Publication date: 01-06-2014
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 6/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-3256-4

At a glance: The STEP trials

Springer Medicine

Changes in the Adjacent Segment 10 Years After Anterior Lumbar Interbody Fusion for Low-Grade Isthmic Spondylolisthesis

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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