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Adjacent-segment disease after thoracic pedicle screw fixation.

Nitin Agarwal1, Robert F Heary2, Prateek Agarwal3

  • 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Journal of Neurosurgery. Spine
|December 16, 2017
PubMed
Summary

Adjacent-segment disease (ASD) is a concern after spinal fusion. This study found ASD to be less common in the thoracic spine compared to the cervical and lumbar spine after pedicle screw fixation.

Keywords:
ASD = adjacent-segment diseasePJK = proximal junctional kyphosisSVA = sagittal vertical axisadjacent-segment diseasepedicle screw fixationthoracic fusion

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Area of Science:

  • Orthopedics
  • Neurosurgery
  • Spinal Surgery

Background:

  • Pedicle screw fixation is increasingly used in the thoracic spine.
  • Adjacent-segment disease (ASD) is a known complication after spinal fusion, particularly in the cervical and lumbar regions.
  • The incidence of ASD after thoracic pedicle screw fixation requires further investigation.

Purpose of the Study:

  • To review the existing literature on ASD following thoracic pedicle screw fixation.
  • To report the authors' institutional experience with thoracic pedicle screw fixation and its associated complications, including ASD.

Main Methods:

  • A literature review was conducted using online databases like PubMed.
  • A retrospective review of a prospectively maintained database of 123 adult patients who underwent thoracic pedicle screw fixation over 13 years was performed.
  • Preoperative and postoperative radiographic images were analyzed to assess thoracic ASD and instrumentation-related issues.

Main Results:

  • Radiographic fusion was achieved in 93.5% of patients.
  • Seven cases of instrumentation failure and 8 cases of screw lucency were noted.
  • Only one patient developed thoracic adjacent-segment disease (ASD) over a mean follow-up of 50 months.

Conclusions:

  • Thoracic pedicle screw fixation is an effective method for spinal stabilization.
  • Adjacent-segment disease (ASD) appears to be a less frequent complication in the thoracic spine compared to the more mobile cervical and lumbar spine.