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Risk factors for adjacent segment disease development after lumbar fusion
Sergei Masevnin1, Dmitry Ptashnikov1, Dmitry Michaylov1
1Vreden Russian Research Institute of Traumatology and Orthopedics, Saint-Petersburg, Russia.
Asian Spine Journal
|April 23, 2015
Summary
Postoperative sagittal imbalance significantly increases the risk of symptomatic adjacent segment disease (ASD) after long lumbar fusions. For short fusions, preoperative disc degeneration is a more critical factor for ASD development.
Area of Science:
- Spine surgery
- Orthopedics
- Degenerative spine disease
Background:
- Adjacent segment disease (ASD) is a known complication after lumbar fusion.
- Risk factors for ASD are numerous, but consensus on the most significant ones remains elusive.
- Previous studies show inconsistent results regarding ASD development after lumbar fusion.
Purpose of the Study:
- To identify key factors contributing to symptomatic adjacent segment disease (ASD) following lumbar fusion surgery.
- To differentiate risk factors for ASD based on the length of lumbar fusion (long vs. short).
Main Methods:
- Retrospective cohort study of 120 patients undergoing 360° lumbar fusion (2007-2012).
- Patients were divided into two groups: long fusion (≥3 levels, n=60) and short fusion (<3 levels, n=60).
- Follow-up assessments included one and three years post-surgery, evaluating for symptomatic ASD and related factors.
Main Results:
- In long fusion group: 19 cases of symptomatic ASD at 1 year (14 with sagittal imbalance), 31 cases at 3 years (17 with sagittal imbalance).
- In short fusion group: 10 cases of ASD at 1 year (8 with preoperative disc degeneration), 14 cases at 3 years (13 with preoperative disc degeneration).
- Postoperative sagittal imbalance was strongly associated with ASD in long fusions, while preoperative disc degeneration was key in short fusions.
Conclusions:
- Postoperative sagittal imbalance is a significant risk factor for symptomatic ASD in long lumbar fusions due to segment overloading.
- Preoperative degenerative changes in adjacent discs are more influential for ASD development in short lumbar fusions.
- Understanding these distinct risk factors can help optimize surgical planning and patient outcomes.
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