Journal List > J Korean Soc Spine Surg > v.20(4) > 1075993

Choi, Ahn, Lee, Koo, and Shin: A Comparison of Adjacent Segment Diseases Above One Versus Above Two Vertebral Segment after Spinal Fusion of the Degenerative Lumbar Disease

Abstract

Study Design

Retrospective study.

Objective

To compare patients who underwent spinal revision surgery of adjacent segment degeneration with above one and above two vertebral segment preceded by initial spinal fusion surgery.

Summary of Literature Review

The adjacent segment disease(ASD) occurs more frequently at the more proximal segment of the spinal fusion. Also, the preexisting degenerative segments (with discs or facet joints) not included in the fusion procedure, fusion segmental sagittal angle, fixed appliances method, gender, and age, have been accepted as the causes.

Materials and Methods

The patients were watched over a year after the spinal revision operation followed by initial spinal fusion of single or multiple segments; the subjects were limited to 41 patients. The average age, entity of diseases, average duration between the initial spinal fusion and the revision surgery, multiple clinical and radiographic parameters were evaluated and compared.

Results

Using the UCLA grade of intervertebral disc degeneration, the average grade of 1 level upper segment was 2.2 in group A and 1.9 in group B without statistical significance(p=0.426). However, the average grade of 2-level upper segment was 1.8 in group A and 2.4 in group B with significant difference(p=0.021). There was no statistical difference in other factors between the two groups.

Conclusions

Patients with ASD of above two-vertebral segment after spinal fusion were more severe in disc degeneration than those with ASD of above one vertebral segment before initial spinal fusions.

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Table 1.
Patient Demographics
Variable Group A(n=31)(ASD : Just above) Group B(n=10)(ASD : Skipped above) p-value
Age 63.7(42-77) 68.7(57-83) p>0.05
Sex p>0.05
Male 9 3
Female 22 7
Diagnosis p>0.05
Spinal stenosis 21 6
Spondylolisthesis 7 4
Herniated intervertebral disc 3 0
Fusion level p>0.05
One level 16 7
Two level 15 3
Medical comorbidity p>0.05
HTN 9 3
DM 6 0
CRF 1 0
Coronary artery disease 3 0
Cushing syndrome 0 1
RA 1 0
Total 14 4

ASD = adjacent segment degeneration; HTN = hypertension; DM = diabetes mellitus; CRF = chronic renal failure; RA = rheumatoid arthritis

Table 2.
University of California at Los Angeles Grading (UCLA) for Inte vertebral Space Degeneration
Grade Disc-Space Narrowing Osteophytes End plate Sclerosis
I - - -
II + - -
III ± + -
IV ± ± +
Table 3.
Weishaupt's Grading for Facet Degeneration
Grade Critieria
0 Normal facet joint space(2~4 mm width)
1 Narrowing of he facet joint space(<2mm) and/or small ost phytes and/or mild hypertrophy of the articular process
2 Narrowing of the facet joint space and/or moderate osteo phytes and/or moderate hypertrophy of the articular proce and/or mild subarticular bone erosions
3 Narrowing of the facet joint space and/or large osteophyt and/or severe hypertrophy of the articular process and/or
Table 4.
Disk Degeneration Grade. Average of A Group : B Group
UCLA grading 1- level upper segment Group A (ASD : Just above) Group B (ASD : Skipped above) p-value
I 10 4
II 6 3
III 15 3
IV 0 0
Average 2.2 1.9 0.426
UCLA grading 2- level upper segment Group A Group B p-value
I 12 0
II 12 6
III 6 4
IV 0 0
Average 1.8 2.4 0.021
Table 5.
Radiologic Parameters (measurement of degrees except millimeters in disc height, p value of all parameters>0.05)
Variable Group A (n=31)(ASD : Just above) Group B (n=10)(ASD : Skipped above)
Disc height 10 7.6
Preoperative LL 17 17
Immediate postoperative LL 19.8 25.1
Preoperative fused-segment SA 17.3 16
Immediate postoperative fused-segment SA 19.2 17
Table 6.
Disc Degeneration change of one level upper segment in Group
UCLA grading Initial Prerevisional
I 4 0
II 3 6
III 3 4
IV 0 0
Average 1.9 2.4
Table 7.
Revision surgery of Group B
2 level upper 1 level upper PLIF PLF Decompression
PLIF 1 0 0
Decompression 2 2 0
No surgery 0 2 3
Total 3 4 3
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