Risk factors for adjacent segment pathology requiring additional surgery after single-level spinal fusion: impact of pre-existing spinal stenosis demonstrated by preoperative myelography

European Spine Journal - Tập 25 Số 5 - Trang 1542-1549 - 2016
Yugué, Itaru1, Okada, Seiji2, Masuda, Muneaki1, Ueta, Takayoshi1, Maeda, Takeshi1, Shiba, Keiichiro1
1Department of Orthopaedic Surgery, Japan Labour Health and Welfare Organization Spinal Injuries Center, Iizuka, Japan
2Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan

Tóm tắt

We determined the incidence of and risk factors for clinical adjacent segment pathology (C-ASP) requiring additional surgeries among patients previously treated with one-segment lumbar decompression and fusion surgery. We retrospectively analysed 161 consecutive patients who underwent one-segment lumbar decompression and fusion surgery for L4 degenerative spondylolisthesis. Patient age, sex, body mass index (BMI), facet orientation and tropism, laminar inclination angle, spinal canal stenosis ratio [on myelography and magnetic resonance imaging (MRI)], preoperative adjacent segment instability, arthrodesis type, pseudarthrosis, segmental lordosis at L4–5, and the present L4 slip were evaluated by a log-rank test using the Kaplan–Meier method. A multivariate Cox proportional-hazards model was used to analyse all factors found significant by the log-rank test. Of 161 patients, 22 patients (13.7 %) had additional surgeries at cranial segments located adjacent to the index surgery’s location. Pre-existing canal stenosis ≥47 % at the adjacent segment on myelography, greater facet tropism, and high BMI were significant risk factors for C-ASP. The estimated incidences at 10 years postoperatively for each of these factors were 51.3, 39.6, and 32.5 %, and the risks for C-ASP were 4.9, 3.7, and, 3.1 times higher than their counterparts, respectively. Notably, spinal canal stenosis on myelography, but not on MRI, was found to be a significant risk factor for C-ASP (log-rank test P < 0.0001 and 0.299, respectively). Pre-existing spinal stenosis, greater facet tropism, and higher BMI significantly increased C-ASP risk. Myelography is a more accurate method for detecting latent spinal canal stenosis as a risk factor for C-ASP.

Tài liệu tham khảo

citation_journal_title=Spine (Phila Pa 1976); citation_title=The spondylolytic vertebra and its adjacent segment. Mobility measured before and after posterolateral fusion; citation_author=P Axelsson, R Johnsson, B Strömqvist; citation_volume=22; citation_issue=4; citation_publication_date=1997; citation_pages=414-417; citation_doi=10.1097/00007632-199702150-00012; citation_id=CR1 citation_journal_title=Eur Spine J; citation_title=Evaluation of the mobility of adjacent segments after posterior thoracolumbar fixation: a biomechanical study; citation_author=L Bastian, U Lange, C Knop; citation_volume=10; citation_issue=4; citation_publication_date=2001; citation_pages=295-300; citation_doi=10.1007/s005860100278; citation_id=CR2 citation_journal_title=J Bone Joint Surg Am; citation_title=Adjacent segment degeneration in the lumbar spine; citation_author=G Ghiselli, JC Wang, NN Bhatia; citation_volume=86-A; citation_issue=7; citation_publication_date=2004; citation_pages=1497-1503; citation_id=CR3 citation_journal_title=Clin Orthop Surg; citation_title=Survival and prognostic analysis of adjacent segments after spinal fusion; citation_author=DK Ahn, HS Park, DJ Choi; citation_volume=2; citation_issue=3; citation_publication_date=2010; citation_pages=140-147; citation_doi=10.4055/cios.2010.2.3.140; citation_id=CR4 citation_journal_title=Spine J; citation_title=Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis; citation_author=WR Sears, IG Sergides, N Kazemi; citation_volume=11; citation_issue=1; citation_publication_date=2011; citation_pages=11-20; citation_doi=10.1016/j.spinee.2010.09.026; citation_id=CR5 citation_journal_title=Spine (Phila Pa 1976); citation_title=Lumbar clinical adjacent segment pathology: predilection for proximal levels; citation_author=PC Celestre, SR Montgomery, AI Kupperman; citation_volume=39; citation_issue=2; citation_publication_date=2014; citation_pages=172-176; citation_doi=10.1097/BRS.0000000000000094; citation_id=CR6 citation_journal_title=Spine (Phila Pa 1976); citation_title=Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion: comparison of posterior lumbar interbody fusion and posterolateral fusion; citation_author=JC Lee, Y Kim, JW Soh, BJ Shin; citation_volume=39; citation_issue=5; citation_publication_date=2014; citation_pages=E339-E445; citation_doi=10.1097/BRS.0000000000000164; citation_id=CR7 citation_journal_title=Eur Spine J; citation_title=Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion; citation_author=MN Kumar, A Baklanov, D Chopin; citation_volume=10; citation_issue=4; citation_publication_date=2001; citation_pages=314-319; citation_doi=10.1007/s005860000239; citation_id=CR8 citation_journal_title=Spine (Phila Pa 1976); citation_title=Lamina horizontalization and facet tropism as the risk factors for adjacent segment degeneration after PLIF; citation_author=S Okuda, T Oda, A Miyauchi; citation_volume=33; citation_issue=25; citation_publication_date=2008; citation_pages=2754-2758; citation_doi=10.1097/BRS.0b013e31817bb9c2; citation_id=CR9 Cho TK, Lim JH, Kim SH et al (2013) Preoperative Predictable Factors for the Occurrence of Adjacent Segment Degeneration Requiring Second Operation after Spinal Fusion at Isolated L4–L5 Level. J Neurol Surg A Cent Eur Neurosurg [Epub ahead of print] citation_journal_title=Spine (Phila Pa 1976); citation_title=Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis; citation_author=MB Kornblum, JS Fischgrund, HN Herkowitz; citation_volume=29; citation_issue=7; citation_publication_date=2004; citation_pages=726-733; citation_doi=10.1097/01.BRS.0000119398.22620.92; citation_id=CR11 citation_journal_title=Spine (Phila Pa 1976); citation_title=Surgical treatment of adjacent instability after lumbar spine fusion; citation_author=WJ Chen, PL Lai, CC Niu; citation_volume=26; citation_issue=22; citation_publication_date=2001; citation_pages=E519-E524; citation_doi=10.1097/00007632-200111150-00024; citation_id=CR12 citation_journal_title=Spine (Phila Pa 1976); citation_title=Surgical outcomes of degenerative spondylolisthesis with L5–S1 disc degeneration: comparison between lumbar floating fusion and lumbosacral fusion at a minimum 5-year follow-up; citation_author=JC Liao, WJ Chen, LH Chen; citation_volume=36; citation_issue=19; citation_publication_date=2011; citation_pages=1600-1607; citation_doi=10.1097/BRS.0b013e3181f99e11; citation_id=CR13 citation_journal_title=J Orthop Sci; citation_title=The natural clinical course of lumbar spinal stenosis: a longitudinal cohort study over a minimum of 10 years; citation_author=A Minamide, M Yoshida, K Maio; citation_volume=18; citation_issue=5; citation_publication_date=2013; citation_pages=693-698; citation_doi=10.1007/s00776-013-0435-9; citation_id=CR14 Imagama S, Kawakami N, Kanemura T et al (2013) Radiographic adjacent segment degeneration at five years after L4/5 posterior lumbar interbody fusion with pedicle screw instrumentation: evaluation by computed tomography and annual screening with magnetic resonance imaging. J Spinal Disord Tech [Epub ahead of print] citation_journal_title=Eur Spine J; citation_title=Additional decompression at adjacent segments leads to adjacent segment degeneration after PLIF; citation_author=M Miyagi, O Ikeda, S Ohtori; citation_volume=22; citation_issue=8; citation_publication_date=2013; citation_pages=1877-1883; citation_doi=10.1007/s00586-013-2694-8; citation_id=CR16 citation_journal_title=Spine (Phila Pa 1976); citation_title=Relation between laminectomy and development of adjacent segment instability after lumbar fusion with pedicle fixation; citation_author=PL Lai, LH Chen, CC Niu; citation_volume=29; citation_issue=22; citation_publication_date=2004; citation_pages=2527-2532; citation_doi=10.1097/01.brs.0000144408.02918.20; citation_id=CR17 citation_journal_title=Spine (Phila Pa 1976); citation_title=The role of facet joint tropism and facet angle in disc degeneration; citation_author=R Noren, J Trafimow, GB Andersson; citation_volume=16; citation_issue=5; citation_publication_date=1991; citation_pages=530-532; citation_doi=10.1097/00007632-199105000-00008; citation_id=CR18 citation_journal_title=Spine (Phila Pa 1976); citation_title=Facet angles in lumbar disc herniation: their relation to anthropometric features; citation_author=I Karacan, T Aydin, Z Sahin; citation_volume=29; citation_issue=10; citation_publication_date=2004; citation_pages=1132-1136; citation_doi=10.1097/00007632-200405150-00016; citation_id=CR19 citation_journal_title=Indian J Orthop; citation_title=Risk factors for adjacent segment degeneration after surgical correction of degenerative lumbar scoliosis; citation_author=KY Ha, JM Son, JH Im; citation_volume=47; citation_issue=4; citation_publication_date=2013; citation_pages=346-351; citation_doi=10.4103/0019-5413.114912; citation_id=CR20 citation_journal_title=Int J Obes (Lond); citation_title=Disc degeneration of the lumbar spine in relation to overweight; citation_author=M Liuke, S Solovieva, A Lamminen; citation_volume=29; citation_issue=8; citation_publication_date=2005; citation_pages=903-908; citation_doi=10.1038/sj.ijo.0802974; citation_id=CR21 citation_journal_title=BMC Res Notes; citation_title=Histological analysis of surgical lumbar intervertebral disc tissue provides evidence for an association between disc degeneration and increased body mass index; citation_author=C Weiler, M Lopez-Ramos, HM Mayer; citation_volume=4; citation_publication_date=2011; citation_pages=497; citation_doi=10.1186/1756-0500-4-497; citation_id=CR22