Adjacent-segment disease after L3-4 posterior lumbar interbody fusion: does L3-4 fusion have cranial adjacent-segment degeneration similar to that after L4-5 fusion?

被引:8
作者
Aono, Hiroyuki [1 ]
Takenaka, Shota [2 ]
Tobimatsu, Hidekazu [3 ]
Nagamoto, Yukitaka [4 ]
Furuya, Masayuki [1 ]
Yamashita, Tomoya [1 ]
Ishiguro, Hiroyuki [1 ]
Iwasaki, Motoki [4 ]
机构
[1] Osaka Natl Hosp, Natl Hosp Org, Osaka, Japan
[2] Osaka Univ, Grad Sch Med, Osaka, Japan
[3] Bell Land Gen Hosp, Osaka, Japan
[4] Osaka Rosai Hosp, Osaka, Japan
关键词
posterior lumbar interbody fusion; PLIF; adjacent-segment disease; L3-4; late complication; MINIMUM;
D O I
10.3171/2020.3.SPINE20122
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE Posterior lumbar interbody fusion (PLIF) is a widely accepted procedure for degenerative lumbar diseases, and there have been many reports concerning adjacent-segment disease (ASD) after PLIF. In the reports of ASD in which the fusion level was limited to 1 segment, all reports describe ASD of the L3-4 segment after L4-5 PLIF. On the basis of these reports, it is thought that ASD mainly occurs at the cranial segment. However, no report has covered ASD after L3-4 PLIF. Therefore, the authors investigated ASD after L3-4 PLIF. METHODS In conducting a retrospective case series analysis, the authors reviewed a surgical database providing details of all spine operations performed between 2006 and 2017 at a single institution. During that period, PLIF was performed to treat 632 consecutive patients with degenerative lumbar diseases. Of these patients, 71 were treated with L3-4 PLIF alone, and 67 who were monitored for at least 2 years (mean 5.8 years; follow-up rate 94%) after surgery were enrolled in this study. Radiological ASD (R-ASD), symptomatic ASD (S-ASD), and operative ASD (O-ASD) were evaluated. These types of ASD were defined as follows: R-ASD refers to radiological degeneration adjacent to the fusion segment as shown on plain radiographs; S-ASD is a symptomatic condition due to neurological deterioration at the adjacent-segment degeneration; and O-ASD refers to S-ASD requiring revision surgery. RESULTS All patients had initial improvement of neurological symptoms after primary PLIF. R-ASD was observed in 32 (48%) of 67 patients. It occurred at the cranial segment in 12 patients and at the caudal segment in 24; R-ASD at both adjacent segments was observed in 4 patients. Thus, the occurrence of R-ASD was more significant in the caudal segment than in the cranial segment. S-ASD was observed in 10 patients (15%), occurring at the cranial segment in 3 patients and at the caudal segment in 7. O-ASD was observed in 6 patients (9%): at the cranial segment in 1 patient and at the caudal segment in 5. Thus, the rate of involvement of the caudal segment was 67% in R-ASD, 70% in S-ASD, and 83% in O-ASD. CONCLUSIONS The incidences of R-ASD, S-ASD, and O-ASD were 48%, 15%, and 9%, respectively, after L3-4 PLIF for degenerative lumbar diseases. In contrast to ASD after L4-5 PLIF, ASD after L3-4 PLIF was more frequently observed at the caudal segment than at the cranial segment. In follow-up for patients with L3-4 PLIF, surgeons should pay attention to ASD in the caudal segment. METHODS In conducting a retrospective case series analysis, the authors reviewed a surgical database providing details of all spine operations performed between 2006 and 2017 at a single institution. During that period, PLIF was performed to treat 632 consecutive patients with degenerative lumbar diseases. Of these patients, 71 were treated with L3-4 PLIF alone, and 67 who were monitored for at least 2 years (mean 5.8 years; follow-up rate 94%) after surgery were enrolled in this study. Radiological ASD (R-ASD), symptomatic ASD (S-ASD), and operative ASD (0-ASD) were evaluated. These types of ASD were defined as follows: R-ASD refers to radiological degeneration adjacent to the fusion segment as shown on plain radiographs; S-ASD is a symptomatic condition due to neurological deterioration at the adjacent-segment degeneration; and 0-ASD refers to S-ASD requiring revision surgery.
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收藏
页码:455 / 460
页数:6
相关论文
共 18 条
[1]   Fusion Rate and Clinical Outcomes in Two-Level Posterior Lumbar Interbody Fusion [J].
Aono, Hiroyuki ;
Takenaka, Shota ;
Nagamoto, Yukitaka ;
Tobimatsu, Hidekazu ;
Yamashita, Tomoya ;
Furuya, Masayuki ;
Iwasaki, Motoki .
WORLD NEUROSURGERY, 2018, 112 :E473-E478
[2]   Adjacent segment degeneration after single-segment PLIF: the risk factor for degeneration and its impact on clinical outcomes [J].
Chen, Bai-Ling ;
Wei, Fu-Xin ;
Ueyama, Kazumasa ;
Xie, Deng-Hui ;
Sannohe, Akio ;
Liu, Shao-Yu .
EUROPEAN SPINE JOURNAL, 2011, 20 (11) :1946-1950
[3]   Prevalence and Pattern of Lumbar Magnetic Resonance Imaging Changes in a Population Study of One Thousand Forty-Three Individuals [J].
Cheung, Kenneth M. C. ;
Karppinen, Jaro ;
Chan, Danny ;
Ho, Daniel W. H. ;
Song, You-Qiang ;
Sham, Pak ;
Cheah, Kathryn S. E. ;
Leong, John C. Y. ;
Luk, Keith D. K. .
SPINE, 2009, 34 (09) :934-940
[5]   Comparison of posterolateral fusion with and without additional posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis [J].
Ha, Kee-Yong ;
Na, Ki-Ho ;
Shin, Jae-Hyuk ;
Kim, Ki-Won .
JOURNAL OF SPINAL DISORDERS & TECHNIQUES, 2008, 21 (04) :229-234
[6]   Radiographic Adjacent Segment Degeneration at 5 Years After L4/5 Posterior Lumbar Interbody Fusion With Pedicle Screw Instrumentation Evaluation by Computed Tomography and Annual Screening With Magnetic Resonance Imaging [J].
Imagama, Shiro ;
Kawakami, Noriaki ;
Matsubara, Yuji ;
Tsuji, Taichi ;
Ohara, Tetsuya ;
Katayama, Yoshito ;
Ishiguro, Naoki ;
Kanemura, Tokumi .
CLINICAL SPINE SURGERY, 2016, 29 (09) :E442-E451
[7]   Induction of early degeneration of the adjacent segment after posterior lumbar interbody fusion by excessive distraction of lumbar disc space Clinical article [J].
Kaito, Takashi ;
Hosono, Noboru ;
Mukai, Yoshihiro ;
Makino, Takahiro ;
Fuji, Takeshi ;
Yonenobu, Kazuo .
JOURNAL OF NEUROSURGERY-SPINE, 2010, 12 (06) :671-679
[8]   Adjacent Segment Disease After Interbody Fusion and Pedicle Screw Fixations for Isolated L4-L5 Spondylolisthesis A Minimum Five-Year Follow-up [J].
Kim, Kyeong Hwan ;
Lee, Sang-Ho ;
Shim, Chan Shik ;
Lee, Dong Yeob ;
Park, Hyeon Seon ;
Pan, Woei-Jack ;
Lee, Ho-Yeon .
SPINE, 2010, 35 (06) :625-634
[9]  
Nakai S, 1999, J SPINAL DISORD, V12, P293
[10]   Adjacent Segment Disease After Posterior Lumbar Interbody Fusion Based on Cases With a Minimum of 10 Years of Follow-up [J].
Nakashima, Hiroaki ;
Kawakami, Noriaki ;
Tsuji, Taichi ;
Ohara, Tetsuya ;
Suzuki, Yoshitaka ;
Saito, Toshiki ;
Nohara, Ayato ;
Tauchi, Ryoji ;
Ohta, Kyotaro ;
Hamajima, Nobuyuki ;
Imagama, Shiro .
SPINE, 2015, 40 (14) :E831-E841