Clinical Results and Changes of Adjacent Segment after Whole Lumbosacral Fusion

Jae-Lim Cho; Ye-Soo Park; Jong-Pil Yoon

doi:10.4055/jkoa.2008.43.2.160

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Cho, Park, and Yoon: Clinical Results and Changes of Adjacent Segment after Whole Lumbosacral Fusion

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(2): 160-165.

Published online: 30 April 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.2.160

Clinical Results and Changes of Adjacent Segment after Whole Lumbosacral Fusion

Jae-Lim Cho, M.D.^*, Ye-Soo Park, M.D., Jong-Pil Yoon, M.D.

^*Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea.

Department of Orthopaedic Surgery, Guri Hospital, Hanyang University College of Medicine, Guri, Korea.

Address reprint requests to Ye-Soo Park, M.D. Department of Orthopaedic Surgery, Guri Hospital, Hanyang University College of Medicine, 249-1, Gyomun-dong, Guri 471-701, Korea. Tel: +82.31-560-2317, Fax: +82.31-557-8781, hyparkys@hanyang.ac.kr

Abstract

Purpose

To analyze the clinical and radiological results of whole lumbosacral fusion, and to identify whether an extension of the fusion level is required.

Materials and Methods

A retrospective review was carried out on 40 patients who had undergone whole lumbosacral fusion. The adjacent segment changes were evaluated by the radiological findings including intervertebral space narrowing, traction spur, endplate sclerosis and vacuum phenomenon. The clinical results were evaluated using a visual analogue scale (VAS) and Oswestry disability index (ODI).

Results

The mean age was 63.8 years and the mean follow-up period was 41.7 months. At the last follow-up, adjacent segment changes were observed in 12 cases of intervertebral space narrowing, 15 cases of traction spur, 20 cases of endplate sclerosis and 8 cases of vacuum phenomenon. In the clinical results, the VAS was improved to 4.0 points from 7.6 points, and the ODI improved to 43.9% from 86.0%. There were no revision cases due to adjacent segment problems.

Conclusion

Whole lumbosacral fusion in spinal stenosis with degenerative lumbar scoliosis was concomitant with some adjacent segment problems, but presented favorable outcomes. For the prevention of junctional problem, caution should be taken when extending the fusion level to the proximal level in whole lumbosacral fusion.

Keywords: Whole lumbosacral fusion, Adjacent segment

Figures and Tables

Fig. 1

69-year-old female patient. (A) Preoperative X-ray showed degenerative changes with mild scoliosis. (B) At postoperative 42 months, the X-ray showed no additional adjacent segmental changes compared with the preoperative state and bony union was well done.

Fig. 2

53-year-old female patient. (A) Preoperative X-ray showed degenerative lumbar disease with scoliosis. (B) At postoperative 39 months, the X-ray was showed intervertebral space narrowing, a traction spur, end plate sclerosis and vacuum phenomenon of the adjacent segment. However, the patient was satisfied with the result of the operation and did not complain of low back pain or radiating pain.

Table 1

Radiological Finding of the Adjacent Segments Change

^*Chi-square test, Fisher's exact test, p<0.05

Table 2

Oswestry Disability Index

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