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Risk factors for predicting symptomatic adjacent segment degeneration requiring surgery in patients after posterior lumbar fusion.

Liang J, Dong Y, Zhao H - J Orthop Surg Res (2014)

Bottom Line: Mean postoperative lumbar lordosis was smaller (p = 0.000) in symptomatic adjacent segment degeneration surgery (SASDS) group compared with in the control group (33.3° vs. 39.8°).Postoperative adjacent disc height was also significantly lower in the former group compared with the latter group (p = 0.002).Logistic regression analysis showed that body mass index (BMI) (OR: 1.75; p = 0.006), preoperative adjacent disc degeneration (ADD) on MRI (OR: 13.52; p = 0.027), and disc bulge in preoperative CT examination (OR: 390.4; p = 0.000) maintained their significance in predicting likelihood of symptomatic adjacent segment degeneration surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, 100730, Beijing, China. string218@126.com.

ABSTRACT

Background: Although measures to reduce and treat degenerative changes after fusion are discussed, these are still controversial.

Methods: A retrospective study was conducted on a consecutive series of 3,799 patients who underwent posterior lumbar fusion for degenerative lumbar disease between January 1999 and January 2009. A total of 28 patients with symptomatic adjacent segment degeneration surgery were identified. Another group of 56 matched patients with degenerative lumbar disease without symptomatic adjacent segment degeneration after spinal fusion were marked as the control group. These two groups were compared for demographic distribution and clinical and radiographic data to investigate the predictive factors of symptomatic adjacent segment degeneration surgery by logistic regression.

Results: The overall incidence rate of symptomatic adjacent segment degeneration surgery was 0.74%. Strong risk factors for the development of a symptomatic adjacent segment degeneration requiring surgery were preoperative distance from L1 to S1 sagittal plumb line (p = 0.031), preoperative lumbar lordosis (p = 0.005), and preoperative adjacent disc height (p = 0.003). Mean postoperative lumbar lordosis was smaller (p = 0.000) in symptomatic adjacent segment degeneration surgery (SASDS) group compared with in the control group (33.3° vs. 39.8°). Postoperative adjacent disc height was also significantly lower in the former group compared with the latter group (p = 0.002). Logistic regression analysis showed that body mass index (BMI) (OR: 1.75; p = 0.006), preoperative adjacent disc degeneration (ADD) on MRI (OR: 13.52; p = 0.027), and disc bulge in preoperative CT examination (OR: 390.4; p = 0.000) maintained their significance in predicting likelihood of symptomatic adjacent segment degeneration surgery.

Conclusions: The occurrence of a symptomatic adjacent segment degeneration surgery is most likely multifactorial and is related to BMI, preoperative ADD on MRI, and disc bulge in preoperative CT examination.

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Related in: MedlinePlus

Radiographs assessed for slope angle, disc angle, and disc height. Radiographs assessed for S1 sagittal slope angle (A), adjacent disc angle (B), and adjacent disc height (C).
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Fig2: Radiographs assessed for slope angle, disc angle, and disc height. Radiographs assessed for S1 sagittal slope angle (A), adjacent disc angle (B), and adjacent disc height (C).

Mentions: Routine lateral radiographs were obtained using standard techniques. The patient stands upright, his or her head facing forward. The X-ray tube is positioned 72 in from the patient. The lumbar lordotic angle was measured by Cobb’s angle made by the upper endplate of the first lumbar vertebra and the upper endplate of the sacrum. The L1 sagittal plumb line was drawn with a lateral gravity plumb line from the center of L1 (Figure 1). The center of L1 was noted by the intersection of crossing diagonals of vertebral body of L1 on the lateral radiograph. The S1 sagittal plumb line was drawn with a lateral gravity plumb line from the posterior end of S1 vertebrae (Figure 1). The distance between the plumb lines was measured as the shortest perpendicular distance between the two lines (Figure 1). The sagittal slope angle of the superior end plate of S1 was measured as the angle between a horizontal line and the superior end plate of S1 (Figure 2). The adjacent disc angle was measured as the angle between the caudal and cranial end plates of the disc just adjacent to the upper or lower instrumented/fused levels (UIV or LIV) (Figure 2). The adjacent disc height was measured on lateral radiograph from the middle of the superior border of the disc to the middle of the inferior border of the disc just adjacent to the upper or lower instrumented/fused levels (UIV or LIV) (Figure 2).Figure 1


Risk factors for predicting symptomatic adjacent segment degeneration requiring surgery in patients after posterior lumbar fusion.

Liang J, Dong Y, Zhao H - J Orthop Surg Res (2014)

Radiographs assessed for slope angle, disc angle, and disc height. Radiographs assessed for S1 sagittal slope angle (A), adjacent disc angle (B), and adjacent disc height (C).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4197214&req=5

Fig2: Radiographs assessed for slope angle, disc angle, and disc height. Radiographs assessed for S1 sagittal slope angle (A), adjacent disc angle (B), and adjacent disc height (C).
Mentions: Routine lateral radiographs were obtained using standard techniques. The patient stands upright, his or her head facing forward. The X-ray tube is positioned 72 in from the patient. The lumbar lordotic angle was measured by Cobb’s angle made by the upper endplate of the first lumbar vertebra and the upper endplate of the sacrum. The L1 sagittal plumb line was drawn with a lateral gravity plumb line from the center of L1 (Figure 1). The center of L1 was noted by the intersection of crossing diagonals of vertebral body of L1 on the lateral radiograph. The S1 sagittal plumb line was drawn with a lateral gravity plumb line from the posterior end of S1 vertebrae (Figure 1). The distance between the plumb lines was measured as the shortest perpendicular distance between the two lines (Figure 1). The sagittal slope angle of the superior end plate of S1 was measured as the angle between a horizontal line and the superior end plate of S1 (Figure 2). The adjacent disc angle was measured as the angle between the caudal and cranial end plates of the disc just adjacent to the upper or lower instrumented/fused levels (UIV or LIV) (Figure 2). The adjacent disc height was measured on lateral radiograph from the middle of the superior border of the disc to the middle of the inferior border of the disc just adjacent to the upper or lower instrumented/fused levels (UIV or LIV) (Figure 2).Figure 1

Bottom Line: Mean postoperative lumbar lordosis was smaller (p = 0.000) in symptomatic adjacent segment degeneration surgery (SASDS) group compared with in the control group (33.3° vs. 39.8°).Postoperative adjacent disc height was also significantly lower in the former group compared with the latter group (p = 0.002).Logistic regression analysis showed that body mass index (BMI) (OR: 1.75; p = 0.006), preoperative adjacent disc degeneration (ADD) on MRI (OR: 13.52; p = 0.027), and disc bulge in preoperative CT examination (OR: 390.4; p = 0.000) maintained their significance in predicting likelihood of symptomatic adjacent segment degeneration surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, 100730, Beijing, China. string218@126.com.

ABSTRACT

Background: Although measures to reduce and treat degenerative changes after fusion are discussed, these are still controversial.

Methods: A retrospective study was conducted on a consecutive series of 3,799 patients who underwent posterior lumbar fusion for degenerative lumbar disease between January 1999 and January 2009. A total of 28 patients with symptomatic adjacent segment degeneration surgery were identified. Another group of 56 matched patients with degenerative lumbar disease without symptomatic adjacent segment degeneration after spinal fusion were marked as the control group. These two groups were compared for demographic distribution and clinical and radiographic data to investigate the predictive factors of symptomatic adjacent segment degeneration surgery by logistic regression.

Results: The overall incidence rate of symptomatic adjacent segment degeneration surgery was 0.74%. Strong risk factors for the development of a symptomatic adjacent segment degeneration requiring surgery were preoperative distance from L1 to S1 sagittal plumb line (p = 0.031), preoperative lumbar lordosis (p = 0.005), and preoperative adjacent disc height (p = 0.003). Mean postoperative lumbar lordosis was smaller (p = 0.000) in symptomatic adjacent segment degeneration surgery (SASDS) group compared with in the control group (33.3° vs. 39.8°). Postoperative adjacent disc height was also significantly lower in the former group compared with the latter group (p = 0.002). Logistic regression analysis showed that body mass index (BMI) (OR: 1.75; p = 0.006), preoperative adjacent disc degeneration (ADD) on MRI (OR: 13.52; p = 0.027), and disc bulge in preoperative CT examination (OR: 390.4; p = 0.000) maintained their significance in predicting likelihood of symptomatic adjacent segment degeneration surgery.

Conclusions: The occurrence of a symptomatic adjacent segment degeneration surgery is most likely multifactorial and is related to BMI, preoperative ADD on MRI, and disc bulge in preoperative CT examination.

Show MeSH
Related in: MedlinePlus