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Pathoanatomic Risk Factors for Instability and Adjacent Segment Disease in Lumbar Spine: How to Use Topping Off?
J Bredow1,2, L Löhrer1, J Oppermann2
1Center for Spinal Surgery, Schön Klinik Düsseldorf SE & Co. KG, Am Heerdter Krankenhaus 2, 40549 Düsseldorf, Germany.
Biomed Research International
|August 24, 2017
Summary
Hybrid lumbar spine instrumentation may prevent adjacent segment disease (ASDi), but evidence is limited. Further research is needed to confirm the effectiveness of this surgical technique.
Area of Science:
- Spine surgery
- Orthopedic technology
- Biomechanical engineering
Background:
- Adjacent Segment Disease (ASDi) is a potential complication following lumbar fusion surgery.
- Factors predisposing to ASDi include laminar horizontalization, fascial insufficiency, facet tropism, and sagittalization.
Purpose of the Study:
- To identify criteria for hybrid system implantation in the lumbar spine.
- To evaluate the general benefits of using hybrid systems for preventing ASDi.
Main Methods:
- Systematic review of literature.
- Included randomized clinical trials, reviews, and meta-analyses.
- Searched Medline Library for human studies up to May 2015.
Main Results:
- Limited evidence exists regarding the use of hybrid systems for ASDi avoidance.
- Only 12 studies were found with no consistent statements on effectiveness.
- No evidence currently supports 'topping off' as a preventative measure.
Conclusions:
- Hybrid instrumentation may potentially prevent ASDi in segments adjacent to fusion.
- Clinical data proving the effectiveness of hybrid systems is currently unavailable.
- Radiological classifications and pathoanatomical conditions are crucial for treatment decisions.
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