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Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
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Lumbar clinical adjacent segment pathology: predilection for proximal levels
Paul C Celestre1, Scott R Montgomery, Asher I Kupperman
1*Norton Leatherman Spine Center, Louisville, KY †UCLA Department of Orthopaedic Surgery, Los Angeles, CA; and ‡USC Spine Center, Los Angeles, CA.
Spine
|October 25, 2013
Summary
Adjacent segment pathology (ASP) most frequently affects levels above lumbar fusions, with L3-L4 being most common after L4-L5 fusion. Surgeons should monitor proximal segments closely for adjacent segment pathology after lumbar fusion.
Area of Science:
- Spine surgery
- Orthopedics
- Degenerative spine disease
Background:
- Adjacent segment pathology (ASP) is a significant clinical issue following lumbar arthrodesis.
- The precise distribution of commonly affected spinal levels in ASP remains debated.
Purpose of the Study:
- To investigate the reoperation rates and affected levels for lumbar adjacent segment pathology (ASP) over a decade.
- To identify specific risk factors and patterns of ASP following lumbar fusion procedures.
Main Methods:
- Retrospective case series analysis of 31 patients undergoing revision surgery for lumbar ASP.
- Evaluation of patient charts for demographic data, fusion levels, and time to revision surgery.
Main Results:
- The L4-L5 level was most frequently fused in index operations.
- Adjacent segment pathology (ASP) most commonly occurred at the L3-L4 level (75%), particularly after L4-L5 single-level fusions (83%).
- Ninety percent of all ASP cases involved levels proximal to the initial fusion.
Conclusions:
- Adjacent segment pathology (ASP) predominantly affects proximal lumbar levels post-fusion.
- L3-L4 is at high risk after L4-L5 fusion, while L5-S1 appears relatively protected.
- Surgeons must carefully consider proximal segments when planning lumbar arthrodesis due to the high incidence of ASP.
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