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Demographic, Surgical, and Radiographic Risk Factors for Symptomatic Adjacent Segment Disease After Lumbar Fusion: A
Kenney K L Lau1,2, Dino Samartzis3,4, Nicholas S C To1
1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR.
The Journal of Bone and Joint Surgery. American Volume
|June 24, 2021
Summary
Symptomatic adjacent segment disease (ASD) after lumbar fusion is linked to factors like high BMI and specific spinal alignment changes. Understanding these risk factors is crucial for managing ASD and guiding future research.
Area of Science:
- Spine surgery
- Orthopedics
- Biomechanical engineering
Background:
- Symptomatic adjacent segment disease (ASD) is a known complication following lumbar fusion.
- Previous studies on ASD risk factors have yielded inconsistent findings.
- A comprehensive summary of risk factors is needed to guide clinical management and research.
Purpose of the Study:
- To systematically review and synthesize the existing literature on risk factors for symptomatic adjacent segment disease (ASD) after lumbar fusion.
- To provide a consolidated evidence base for understanding ASD etiology.
- To inform future research directions and clinical practice guidelines for lumbar fusion patients.
Main Methods:
- Systematic literature search of six electronic databases (inception to December 2019).
- Independent screening of titles, abstracts, and full-text articles by two reviewers.
- Methodological quality assessment and strength of evidence evaluation for identified risk factors.
Main Results:
- Sixteen studies with 3,553 patients were included in the meta-analysis.
- Significant risk factors identified include high body mass index, facet joint violation, and sagittal plane malalignments (e.g., anterior shift of plumb line, decreased lumbar lordosis, increased lumbopelvic mismatch).
- Preoperative factors like adjacent disc degeneration and decreased disc height, along with postoperative pelvic parameters (incidence, tilt), were also associated with ASD.
Conclusions:
- This meta-analysis provides a robust summary of risk factors for ASD following lumbar fusion, addressing limitations of prior reviews.
- Identified risk factors offer targets for potential intervention and risk stratification.
- Future prospective studies are recommended to investigate the impact of modifying these risk factors on ASD development.
