Revision Surgery for Spinal Stenosis Developed at the Adjacent Segment after Lumbar Fusion

Kyu Jung Cho; Seung Rim Park; Jae Hoon Jung; Joo Hyun Park

doi:10.4055/jkoa.2011.46.3.205

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Cho, Park, Jung, and Park: Revision Surgery for Spinal Stenosis Developed at the Adjacent Segment after Lumbar Fusion

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(3): 205-211.

Published online: 30 June 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.3.205

Revision Surgery for Spinal Stenosis Developed at the Adjacent Segment after Lumbar Fusion

Kyu Jung Cho, M.D., Seung Rim Park, M.D., Jae Hoon Jung, M.D., Joo Hyun Park, M.D.

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

Correspondence to: Kyu Jung Cho, M.D. Department of Orthopedic Surgery, Inha University School of Medicine, 7-206 3rd ST, Sinheung-dong, Jung-gu, Incheon 400-711, Korea. TEL: +82-32-890-3661, FAX: +82-32-890-3099, chokj@inha.ac.kr

Received 7 December 2010 Accepted 27 April 2011

(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 determine the factors influencing clinical results of revision surgery for spinal stenosis developed at the adjacent segment after spinal fusion.

Materials and Methods

Nineteen patients underwent revision surgery by adjacent segment disease after decompression and posterolateral fusion with pedicle screw instrumentation for spinal stenosis. The control group was matched in terms of age, sex, and number of fused segment, posterior interbody fusion.

Results

Oswestry disability index (ODI) was changed from 32.1 before surgery to 28.0 at the final follow up in the revision group. Compared to the improvement from 27.6 to 15.2 in the control group, there was a significant difference between both groups (p=0.002). Revision group had 1 nonunion and 2 proximal screw loosening. There was no late complication in the control group. In the revision group, 12 of 19 patients had disc degeneration before surgery at the upper lumbar segments which was not included in the fusion. They had an average 2.0 ODI improvement after revision surgery. On the other hand, 7 patients who had no degeneration at the unfused segment showed 7.4 ODI improvement.

Conclusion

The clinical result of revision surgery for spinal stenosis at the adjacent segment after spinal fusion was less satisfactory than the primary surgery. The contributing factors were late complications and preoperative disc degeneration at the segments which was not included in the fusion.

Keywords: adjacent segment disease, spinal stenosis, revision surgery, clinical outcome, spinal fusion

Figures and Tables

Figure 1

A 58-years-old woman underwent posterior fusion for spinal stenosis 5 years ago. Lateral radiograph shows disc space narrowing at L3-4 and L2-3.

Figure 2

Postoperative lateral radiograph shows extension of fusion to L3.

Figure 3

Preoperative sagittal MRI showed spinal stenosis at L3-4, which was treated by revision surgery. In addition, it showed disc degeneration at L1-2 and L2-3, which were not fused in the revision surgery. The axial images showed L1-2 and L3-4.

Table 1

Demographic Data

Table 2

Operation Time and Estimated Blood Loss

Table 3

Radiologic Disc Degeneration at Un-fused Segments Above Fusion before Surgery

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