Comparative Analysis of Revision Surgery Groups between within 5 Years and More than 10 Years after Lumbar Spinal Fusion Due to Adjacent Segment Disease

Jaewan Soh; Junghyeok Kim; Jae Chul Lee; Byung-Joon Shin

doi:10.4055/jkoa.2016.51.3.214

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Soh, Kim, Lee, and Shin: Comparative Analysis of Revision Surgery Groups between within 5 Years and More than 10 Years after Lumbar Spinal Fusion Due to Adjacent Segment Disease

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(3): 214-220.

Published online: 22 June 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.3.214

Comparative Analysis of Revision Surgery Groups between within 5 Years and More than 10 Years after Lumbar Spinal Fusion Due to Adjacent Segment Disease

Jaewan Soh, M.D., Junghyeok Kim, M.D.^*, Jae Chul Lee, M.D.^*, Byung-Joon Shin, M.D.^*

Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea.

^*Department of Orthopedic Surgery and Spine Center, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.

Correspondence to: Byung-Joon Shin, M.D. Department of Orthopedic Surgery and Spine Center, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea. TEL: +82-2-709-9250, FAX: +82-2-794-9414, schsbj@schmc.ac.kr

Received 23 September 2015 Revised 30 October 2015 Accepted 6 November 2015

(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/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to analyze the risk factors for early adjacent segment disease (EASD) in patients undergoing revision surgery within 5 years from the first operation as compared with those after more than 10 years.

Materials and Methods

A total of 755 patients with degenerative lumbar disease underwent lumbar spinal fusion of 3 or less segments between August, 1988 and May, 2009. Of these, 44 patients underwent revision surgery due to adjacent segment disease (ASD) until May, 2014. These patients presented with ASD, 19 and 13 of whom underwent revision surgery within 5 years and after more than 10 years of the first one, and were thus assigned to group A (n=19) and group B (n=13), respectively. Thirty-two of these patients were enrolled in this study and baseline and clinical characteristics, including sex, age, fusion method, preoperative diagnosis, the number of fused segments, fusion level, and radiological measurements were compared between the two groups. Radiological measurements included pre- and postoperative lumbar lordotic angle (LLA), pre- and postoperative fusion segment lordotic angle (FSLA), pre- and postoperative FSLA per level and the correction of LLA, FSLA, and FSLA per level. For statistical analysis, univariate analysis with the chi-square test was performed using SPSS 14.0.

Results

In group A, the number of patients undergoing posterior lumbar interbody fusion (PLIF) rather than posterolateral fusion, those with postoperative FSLA per level of <20° and the adjacent segment levels to L4-5 and L5-S1 was significantly larger compared with group B (p=0.018, 0.046, and 0.009, respectively.

Conclusion

In conclusion, our results indicate that the degree of risk of EASD was relatively higher in association with PLIF, postoperative FSLA per level of <20° and the adjacent segment levels to L4-5 and L5-S1.

Keywords: lumbar spine, early adjacent segment disease, revision surgery

Figures and Tables

Figure 1

In simple lateral lumbar radiographs, measurements of lumbar lordotic angle (A), fused segment lordotic angle and fused segment lordotic angle per level were estimated (B).

Table 1

Univariate Analysis of Risk Factors for Early Adjacent Segment Disease

Values are presented as number only. ^*Underwent revision surgery within 5 years due to adjacent segment disease. ^†Underwent revision surgery more than 10 years due to adjacent segment disease. LLA, lumbar lordoric angle; FSLA, fused segment lordotic angle; PLIF, posterior lumbar interbody fusion; PLF, posterolateral fusion.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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