The Revision Operation Rate for Adjacent Segmental Degeneration by Survival Analysis in Mono-segment Lumbar Fusion

Tae-Hyung Kim; Jin-Hyok Kim; Sung-Soo Kim; Dong-Ju Lim; Jung-Il Han; Tai-Wan Kim; Se-Il Suk

doi:10.4055/jkoa.2010.45.4.314

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Kim, Kim, Kim, Lim, Han, Kim, and Suk: The Revision Operation Rate for Adjacent Segmental Degeneration by Survival Analysis in Mono-segment Lumbar Fusion

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2010; 45(4): 314-320.

Published online: 9 August 2010

DOI: https://doi.org/10.4055/jkoa.2010.45.4.314

The Revision Operation Rate for Adjacent Segmental Degeneration by Survival Analysis in Mono-segment Lumbar Fusion

Tae-Hyung Kim, M.D., Jin-Hyok Kim, M.D., Sung-Soo Kim, M.D., Dong-Ju Lim, M.D., Jung-Il Han, M.D., Tai-Wan Kim, M.D., Se-Il Suk, M.D.

Seoul Spine Institute, Inje University Sanggye Paik Hospital, Seoul, Korea.

Correspondence to: Jin-Hyok Kim, M.D. Seoul Spine Institute, Inje University Sanggye Paik Hospital, 761-1, Sanggye dong, Nowon-gu, Seoul 139-707, Korea. TEL: +82-2-950-1288, FAX: +82-2-934-6342, kjh1026@paik.ac.kr

Received 26 November 2009 Accepted 5 April 2010

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To analyze survival rates of patients after mono-segmental lumbar or lumbosacral fusion and to evaluate factors affecting the revision operation due to adjacent segmental degeneration.

Materials and Methods

This study enrolled 1,206 patients who had mono-segmental lumbar or lumbosacral fusion between March 1997 and December 2006 at the Seoul Spine Institute. The survival rates for the revision operation due to adjacent segmental degeneration were analyzed retrospectively. The age at index operation, sex, etiologic diagnosis, fusion method, fusion level, substance of bone graft, operator, body mass index (BMI), and smoking were considered as risk factors for the revision operation.

Results

There were 27 patients with a revision operation for adjacent segmental degeneration (2.24%). The average follow-up period was 39.0 months (6 months to 12 years 6 months) and the average age at operation was 47.0 years (13 to 85 years). The survival rate at 5 years was 97.3%, and at 10 years it was 89.4%. Patients less than 50 years old had a significantly lower revision operation rate than those aged 50 or more (p=0.002). When fusion between the 4th lumbar and the 5th lumbar spinal vertebrae was done, the revision operation rate was significantly higher than for other levels (p=0.003). Obese patients with BMI≥25 had a significantly higher revision rate than did patients with BMI<25 (p=0.040). In a comparison of circumferential fusion versus other types of fusion, circumferential fusion had a lower revision rate and the difference was significant (p=0.021). Other factors such as diagnosis, sex, surgeon, substance used for the bone graft, and smoking were not significant for revision rate (ps>0.05). In multivariate analysis, age alone was a significant risk factor (p=0.048, Hazard ratio=2.50).

Conclusion

The most important factor for survival without revision surgery for adjacent segmental degeneration following instrumented mono-segment lumbar or lumbosacral fusion is the age at index operation. Patients 50 year-old or older should be informed of the possibility of adjacent segmental disease after instrumented mono-segment lumbar or lumbosacral fusion.

Keywords: adjacent segmental degeneration, mono-segment fusion, survival rate, revision operation, lumbar spine

Figures and Tables

Figure 1

The survival rate was 97.3% at 5 years, 91.6% at 7 years, and 89.4% at 10 years.

Figure 2

Univariate Analysis. (A) Age at operation, (B) Fusion level, (C) Fusion method, and (D) Obesity.

Table 1

Results of Univariate Analysis

^*Higher risk.

Table 2

Results of Multivariate Analysis

^*Statistically significant.

Table 3

There were 27 Patients with the Revision Operation for Adjacent Segmental Degeneration (2.24%)

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