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Related Experiment Video

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Three-dimensional Navigation-guided, Prone, Single-position, Lateral Lumbar Interbody Fusion Technique

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Published on: July 15, 2021

Incidence Rates and Risks for Reoperations for Nonunion and Adjacent Level Disease: Stopping at L1 Versus T10/T11/12.

Kern H Guppy¹, Richard Chang², Jacob Fennessy¹

¹The Permanente Medical Group, Sacramento, CA.

|January 22, 2025

Summary

Lumbar fusions stopping at L1 showed no increased risk of adjacent segment disease (ASD) or nonunion compared to fusions ending at T10-T12. This suggests crossing the thoracolumbar junction may not be necessary for certain lumbar fusion constructs.

Keywords:

kaiser permanente lumbar fusions operative ASD operative nonunion reoperation for adjacent segment disease spine registry stopping at L1 stopping at T10/T11/T12

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Area of Science:

Spine surgery
Orthopedics
Neurosurgery

Background:

The belief that lumbar fusions must extend to T10/T11/T12 to prevent adjacent segment disease (ASD) is common but lacks robust evidence.
Varied clinical practices exist regarding the optimal stopping point for lumbar fusions.

Purpose of the Study:

To compare reoperation rates for adjacent segment disease (ASD) and nonunion in primary lumbar fusions stopping at L1 versus those extending to T10/T11/T12.
To evaluate the impact of fusion length on surgical outcomes.

Main Methods:

Retrospective cohort study of adult patients with degenerative disc disease or adult lumbar deformity undergoing primary lumbar fusion.
Analysis of a US-based integrated healthcare system's Spine Registry data.
Propensity score-weighted Cox proportional hazards regressions to assess reoperation risks for ASD and nonunion.

Main Results:

No statistically significant differences in reoperation for ASD were found between fusions stopping at L1 versus T10/T11/T12 for caudal levels at L5 and S1.
Short-segment and long-segment fusions also showed no significant difference in operative ASD rates.
Long-segment fusions demonstrated no statistical difference in operative nonunion rates between the two stopping points.

Conclusions:

The study provides evidence against routinely crossing the thoracolumbar junction for fusions terminating at S1 or for long-segment fusions, regarding ASD and nonunion.
Further research is recommended to validate these findings for constructs with caudal levels at L2, L3, L4, and S1+ilium.