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Song, Ko, and Jung: Analysis of Risk Factors of Adjacent Segment Disease with Lumbar and Lumbosacral Arthrodesis for the Degenerative Lumbar Spinal Disorders
Original Article

Journal of the Korean Orthopaedic Association 2016; 51(1): 54-60.

Published online: 23 February 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.1.54

Analysis of Risk Factors of Adjacent Segment Disease with Lumbar and Lumbosacral Arthrodesis for the Degenerative Lumbar Spinal Disorders

Kyung-Jin Song, M.D., Ph.D., Jong-Hyun Ko, M.D., Young-Ran Jung, M.D.

Department of Orthopedic Surgery, Chonbuk National University Medical School, Jeonju, Korea.

Correspondence to: Jong-Hyun Ko, M.D. Department of Orthopedic Surgery, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea. TEL: +82-63-250-1760, FAX: +82-63-271-6538, drhwata@gmail.com

Received 24 June 2014       Revised 16 February 2015       Accepted 5 October 2015

Copyright © 2016 by The Korean Orthopaedic Association

(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 objective of this study is to confirm the effects of risk factors on Adjacent Segment Disease (ASD).

Materials and Methods

The subjects of this study were 793 patients who had degenerative lumbar spine disease and were followed-up for an average period of 7.2 years from January of 1999 to September of 2010 after undergoing spinal fusion. To confirm the risk factors, a study on patient factors, surgical factors and radiologic factors was performed.

Results

Of 793 patients, 69 patients (group A, 8.7%) underwent a secondary surgical treatment due to ASD. Age of patient, sex, bone mineral density, history of smoking and occupation were not statistically significant. Preoperative body mass index (BMI) (≥25 kg/m2) and postoperative increase of BMI were the patient's factor in ASD (p=0.02, p<0.001). Regarding surgical factors, multilevel fusion (more than 3 levels) was higher risk in prevalence of ASD than short level fusion (p=0.01). Degeneration of intervertebral disc (p=0.01) and facet joints (p=0.02), and segmental instability (p=0.001) were also associated with the prevalence of ASD in radiologic factors.

Conclusion

To prevent the occurrence of ASD after lumbosacral fusion, selection of the proper level of fusion preoperatively and modifying the life style with body weight control and reduction of hypermobility after fusion surgery are essential.

Keywords: lumbar spinal disorders, adjacent segment disease, fusion, risk factors

Figures and Tables

Figure 1

The distribution of 37 patients who increased body mass index (BMI) between first and second operation (BMI≥25 kg/m2).

jkoa-51-54-g001
Table 1

Relationship of Age and Sex between Two Groups

jkoa-51-54-i001

A group: adjacent segment disease (ASD) patients with surgical treatment, B group: non-ASD patients.

Table 2

Relationship of Various Factors between Two Groups

jkoa-51-54-i002

A group: adjacent segment disease (ASD) patients with surgical treatment, B group: non-ASD patients.

BMI, body mass index; BMD, bone mineral density.

Table 3

Relationship of Fusion Level and Follow-Up Period between Two Groups

jkoa-51-54-i003

A group: adjacent segment disease (ASD) patients with surgical treatment, B group: non-ASD patients.

Table 4

Relationship of Radiologic Findings between Two Groups

jkoa-51-54-i004

A group: adjacent segment disease (ASD) patients with surgical treatment, B group: non-ASD patients.

Notes

CONFLICTS OF INTEREST The authors have nothing to disclose.

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