Top

European Spine Journal

Published in:

10-08-2023 | Original Article

Risk factors for mechanical complications after fusion extension surgery for lumbar adjacent segment disease

Authors: Young-Hoon Kim, Kee-Yong Ha, Joonghyun Ahn, Hyung-Youl Park, Dong-Gune Chang, Jae-Hak Lim, Sang-Il Kim

Published in: European Spine Journal | Issue 1/2024

Abstract

Purpose

Adjacent segment disease (ASD) is a common complication in fusion surgery. In the event of solid segmental fusion, previous implants can be removed or preserved during fusion extension for ASD. To compare the surgical outcomes of patients with and without implants and analyzes the risk factors for postoperative mechanical complications.

Methods

Patients who underwent fusion extension for lumbar ASD from 2011 to 2019 with a minimum 2 year follow-up were retrospectively reviewed. Spinopelvic parameters were measured preoperatively and postoperatively. Clinical outcomes and surgical complications were compared between groups with implants preserved and removed. Risk factors for mechanical complications, including clinical, surgical, and radiographic factors were analyzed.

Results

Sixty-nine patients (mean age, 69.9 ± 6.9 years) were included. The mean numbers of initial and extended fused segments were 2.8 ± 0.7 and 2.7 ± 0.7, respectively. Previous implants were removed in 43 patients (R group) and preserved in 26 patients (P group). Both groups showed an improvement in clinical outcomes without between-group differences. The operation time was significantly longer in R group (260 vs 207 min, p < 0.001). Mechanical complications occurred in 13 patients (12 in R group and 1 in P group) and reoperation was needed in 3 patients (R group). Implant removal, index fusion surgery including L5-S1, and postoperative sagittal malalignment were risk factors for mechanical complications.

Conclusion

Implant removal was a risk factor for mechanical complications. Index fusion surgery including L5-S1 and postoperative sagittal malalignment were also risk factors for mechanical complications.

Okuda S, Nagamoto Y, Matsumoto T, Sugiura T, Takahashi Y, Iwasaki M (2018) Adjacent segment disease after single segment posterior lumbar interbody fusion for degenerative spondylolisthesis: minimum 10 years follow-up. Spine 43:E1384-e1388. https://doi.org/10.1097/brs.0000000000002710CrossRefPubMed

Lang Z, Li JS, Yang F, Yu Y, Khan K, Jenis LG, Cha TD, Kang JD, Li G (2019) Reoperation of decompression alone or decompression plus fusion surgeries for degenerative lumbar diseases: a systematic review. Eur Spine J 28:1371–1385. https://doi.org/10.1007/s00586-018-5681-2CrossRefPubMed

Ryu DS, Park JY, Kuh SU, Chin DK, Kim KS, Cho YE, Kim KH (2018) Surgical outcomes after segmental limited surgery for adjacent segment disease: the consequences of makeshift surgery. World Neurosurg 110:e258–e265. https://doi.org/10.1016/j.wneu.2017.10.150CrossRefPubMed

Teles AR, Yavin D, Zafeiris CP, Thomas KC, Lewkonia P, Nicholls FH, Swamy G, Jacobs WB (2018) Fractures after removal of spinal instrumentation: revisiting the stress-shielding effect of instrumentation in spine fusion. World Neurosurg 116:e1137–e1143. https://doi.org/10.1016/j.wneu.2018.05.187CrossRefPubMed

Ha KY, Kim YH, Park HY, Min HK, Kim SI (2019) Lumbar disc herniation within solid fused segments after removal of pedicle screws: a case report. JBJS Case Connect 9:e0071. https://doi.org/10.2106/jbjs.Cc.19.00071CrossRefPubMed

Kwon JW, Moon SH, Park SY, Park SJ, Park SR, Suk KS, Kim HS, Lee BH (2022) Lumbar spinal stenosis: review update 2022. Asian Spine J. https://doi.org/10.31616/asj.2022.0366CrossRefPubMedPubMedCentral

Kim GU, Park WT, Chang MC, Lee GW (2022) Diagnostic technology for spine pathology. Asian Spine J. https://doi.org/10.31616/asj.2022.0374CrossRefPubMedPubMedCentral

Lee GW, Shin JH (2018) Comparative study of two surgical techniques for proximal adjacent segment pathology after posterior lumbar interbody fusion with pedicle screws: fusion extension using conventional pedicle screw vs cortical bone trajectory-pedicle screw (cortical screw). World Neurosurg 117:e154–e161. https://doi.org/10.1016/j.wneu.2018.05.218ADSCrossRefPubMed

Tan QC, Wang D, Yang Z, Zhao XL, Zhang Y, Yan YB, Feng YF, Lei W, Zhao X, Wu ZX (2021) Implant preservation versus implant replacement in revision surgery for adjacent segment disease after thoracolumbar instrumentation: a retrospective study of 43 patients. World Neurosurg 150:e511–e519. https://doi.org/10.1016/j.wneu.2021.03.046CrossRefPubMed

10.

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

11.

Kim HJ, Chun HJ, Moon SH, Kang KT, Kim HS, Park JO, Moon ES, Sohn JS, Lee HM (2010) Analysis of biomechanical changes after removal of instrumentation in lumbar arthrodesis by finite element analysis. Med Biol Eng Comput 48:703–709. https://doi.org/10.1007/s11517-010-0621-2CrossRefPubMed

12.

Totoribe K, Chosa E, Tajima N (2004) A biomechanical study of lumbar fusion based on a three-dimensional nonlinear finite element method. J Spinal Disord Tech 17:147–153. https://doi.org/10.1097/00024720-200404000-00012CrossRefPubMed

13.

Hsieh YY, Chen CH, Tsuang FY, Wu LC, Lin SC, Chiang CJ (2017) Removal of fixation construct could mitigate adjacent segment stress after lumbosacral fusion: a finite element analysis. Clin Biomech (Bristol, Avon) 43:115–120. https://doi.org/10.1016/j.clinbiomech.2017.02.011CrossRefPubMed

14.

Sedney CL, Daffner SD, Stefanko JJ, Abdelfattah H, Emery SE, France JC (2016) Fracture of fusion mass after hardware removal in patients with high sagittal imbalance. J Neurosurg Spine 24:639–643. https://doi.org/10.3171/2015.7.Spine15153CrossRefPubMed

15.

McAfee PC, Farey ID, Sutterlin CE, Gurr KR, Warden KE, Cunningham BW (1991) The effect of spinal implant rigidity on vertebral bone density a canine model. Spine 16:S190–S1197. https://doi.org/10.1097/00007632-199106001-00003CrossRefPubMed

16.

Benditz A, Auer S, Spörrer JF, Wolkerstorfer S, Grifka J, Suess F, Dendorfer S (2018) Regarding loads after spinal fusion, every level should be seen separately: a musculoskeletal analysis. Eur Spine J 27:1905–1910. https://doi.org/10.1007/s00586-018-5476-5CrossRefPubMed

17.

Galbusera F, Wilke HJ, Brayda-Bruno M, Costa F, Fornari M (2013) Influence of sagittal balance on spinal lumbar loads: a numerical approach. Clin Biomech (Bristol, Avon) 28:370–377. https://doi.org/10.1016/j.clinbiomech.2013.02.006CrossRefPubMed

18.

Hashimoto K, Aizawa T, Kanno H, Itoi E (2019) Adjacent segment degeneration after fusion spinal surgery-a systematic review. Int Orthop 43:987–993. https://doi.org/10.1007/s00264-018-4241-zCrossRefPubMed

19.

Park WM, Choi DK, Kim K, Kim YJ, Kim YH (2015) Biomechanical effects of fusion levels on the risk of proximal junctional failure and kyphosis in lumbar spinal fusion surgery. Clin Biomech (Bristol, Avon) 30:1162–1169. https://doi.org/10.1016/j.clinbiomech.2015.08.009CrossRefPubMed

20.

Patwardhan AG, Sielatycki JA, Havey RM, Humphreys SC, Hodges SD, Blank KR, Muriuki MG (2021) Loading of the lumbar spine during transition from standing to sitting: effect of fusion versus motion preservation at L4–L5 and L5–S1. Spine J 21:708–719. https://doi.org/10.1016/j.spinee.2020.10.032CrossRefPubMed

Title: Risk factors for mechanical complications after fusion extension surgery for lumbar adjacent segment disease
Authors: Young-Hoon Kim
Kee-Yong Ha
Joonghyun Ahn
Hyung-Youl Park
Dong-Gune Chang
Jae-Hak Lim
Sang-Il Kim
Publication date: 10-08-2023
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 1/2024
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-023-07880-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk factors for mechanical complications after fusion extension surgery for lumbar adjacent segment disease

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Are severity and location of facial trauma risk factors for cervical spine injuries? 10-year analysis based on the use of the AO spine injury classification and the comprehensive facial injury (CFI) score

Novel Modic grading scoring system and its clinical validation: a preliminary investigation

Correction: Degenerative lumbar spondylolisthesis: review of current classifications and proposal of a novel classification system

Cervical vertebral Hounsfield units are a better predictor of Zero-P subsidence than the T-score of DXA in patients following single-level anterior cervical discectomy and fusion with zero-profile anchored spacer

Lower preoperative Hounsfield unit values as a risk factor for poor 5-year clinical outcomes after lumbar spine surgery

Myelopathy resulting from degenerative atlantoaxial subluxation