Progression of Preoperative Degeneration of the Adjacent Segment after Instrumented Lumbar Arthrodesis

Kyu-Jung Cho; Seung-Rim Park; Kyung-Ho Moon; Kang-Yun Lee; Kyung-Hoon Kim; Suk-Bong Kang

doi:10.4055/jkoa.2007.42.4.453

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Cho, Park, Moon, Lee, Kim, and Kang: Progression of Preoperative Degeneration of the Adjacent Segment after Instrumented Lumbar Arthrodesis

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(4): 453-460.

Published online: 31 August 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.4.453

Progression of Preoperative Degeneration of the Adjacent Segment after Instrumented Lumbar Arthrodesis

Kyu-Jung Cho, M.D., Seung-Rim Park, M.D., Kyung-Ho Moon, M.D., Kang-Yun Lee, M.D., Kyung-Hoon Kim, M.D., Suk-Bong Kang, M.D.

Department of Orthopedic Surgery, Inha University College of Medicine, Incheon, Korea.

Address reprint requests to Kyu-Jung Cho, M.D. Department of Orthopedic Surgery, Inha University Hospital, 7-206, 3rd Street Sinheung-dong, Jung-gu, Incheon 400-103, Korea. Tel: +82.32-890-3043, Fax: +82.32-890-3047, chokj@inha.ac.kr

Abstract

Purpose

Preoperative degeneration has not been clearly defined as a risk factor of adjacent segment disease (ASD). The aim of this study was to analyze the progression of preoperative degeneration at the adjacent segment after instrumented lumbar fusion.

Materials and Methods

Forty-eight patients (mean age: 63.9, range: 39-77) who underwent posterolateral fusion for a degenerative lumbar spine were reviewed. All the patients showed preoperative degenerative changes at the adjacent segment. The preoperative degeneration included disc degeneration (n=42), degenerative lumbar scoliosis (n=7), posterior translation (n=7), lateral translation (n=9), and spondylolisthesis (n=1). The patients were divided into the following three groups according to the progression of degeneration: Group I, No progression; Group II, asymptomatic radiographic progression; and Group III, symptomatic progression.

Results

There were 22, 15, and 11 patients in Groups I, II and III, respectively. The incidence of symptomatic progression of degeneration was 22.9%. Of the 42 patients showing disc degeneration, 9 patients (21.4%) developed symptomatic progression. On the other hand, 3 out of 7 (42.9%) patients with posterior translation and 5 out of 7 (71.4%) patients with degenerative scoliosis developed symptomatic progression. The age and number of fused segments were not predisposing factors to progression.

Conclusion

The incidence of symptomatic adjacent segment disease in patients with preoperative degeneration was 22.9%. Preoperative coronal malalignment and posterior translation might be risk factors for adjacent segment disease. Correct selection of the fusion level is important for reducing the incidence of adjacent segment disease.

Keywords: Degeneration, Adjacent segment disease, Lumbar fusion

Figures and Tables

Fig. 1

New protocol for measuring the height of the lumbar discs. Ventral and dorsal midpoints, midplanes, and their bisectrix were constructed. The ventral height of the disc was determined by the sum of the distances of corner 4 of the cranial vertebra and corner 2 of the caudal vertebra from the bisectrix. In order to compensate for the variations in stature and magnification, the ventral disc height is divided by the mean depth of the cranial vertebra. A correction converts the measured heights to the disc height at a standard angle of lordosis. Angle standardization allows a comparison of the disc height from the radiographs taken in different postures6).

Fig. 2

Preoperative radiographs of the lumbar spine. A 75-year-old man with spinal stenosis at L3-5 and degenerative lumbar scoliosis. (A) Anteroposterior radiograph showing degenerative lumbar scoliosis. (B) Lateral radiograph showing a well preserved disc space at L2-3.

Fig. 3

(A, B) 5 years after surgery, the anteroposterior and lateral radiographs showed severe loss of disc space at L2-3. This patient developed symptomatic adjacent segment disease. (C) MRI showed spinal stenosis at L2-3.

Table 1

Demographic Data of the Three Groups

^*Statistical analysis by ANOVA test, ^†Statistical analysis by Chi-square test.

Table 2

Number of Patients with Preoperative Radiological Degeneration in Each Group

Table 3

Radiographic Parameters of Preoperative Degeneration at the Adjacent Segment

^*Statistical analysis by ANOVA test (except disc degeneration), ^†Statistical analysis by Chi-square test.

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