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Song, Choi, Song, and Kim: The Causes of Revision Arthrodesis for the Degenerative Changes at the Adjacent Segment after Lumbosacral Fusion for Degenerative Lumbar Diseases
Original Research

Journal of Korean Spine Surg 2008;15(4):230-235.

Published online: 18 January 2008

DOI: https://doi.org/10.7469/JKSS.2008.15.4.230

The Causes of Revision Arthrodesis for the Degenerative Changes at the Adjacent Segment after Lumbosacral Fusion for Degenerative Lumbar Diseases

Kyung-Jin Song, M.D., Byung-Wan Choi, M.D.#, Ji-Hun Song, M.D., Gyu-Hyung Kim, M.D.

Department of Orthopedic Surgery, College of Medicine, Institute for Clinical Medicine, Chonbuk National University, Hospital, Jeonju, Korea

#Department of Orthopedic Surgery, Veterans Hospital, Gwangju, Korea

Address reprint requests to Gyu-Hyung Kim M.D Department of Orthopedic Surgery, Chonbuk University Hospital 634-18, Keum Am-dong, Dukjin-gu, Jeonju-si, Chonbuk, 561-712, Korea Tel: 82-63-250-1760, Fax: 82-63-271-6538, E-mail: cbnuhosman@naver.com

∗ 본 논문은 전북대학교병원부설 임상의학연구소의 일부 지원에 의해 연구되었음.

Copyright © 2008 Korean Society of Spine Surgery

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

Study Design

A Retrospective study

Objectives

To analyze the causes of revision arthrodesis for the degenerative changes at the adjacent segment after lumbosacral fusion for degenerative lumbar diseases.

Summary of Literature Review

Revision arthrodesis is quite common. However, there is some controversy regarding the causes and risk factors.

Materials and Methods

Twenty cases who had undergone revision arthrodesis after lumbosacral fusion were examined. Preexisting degenerative changes to the adjacent segment, location of the adjacent segment and extent of fusion, as well as changes in lumbar lordosis were observed in primary arthrodesis, and the relationship between the changes in the adjacent segment degeneration were analyzed in terms of the area of residence, activity level and living pattern of the patients.

Results

Preexisting degenerative changes in the adjacent segment were observed in 14 cases and degenerative changes developed at the proximal junction in 19. Multiple segment fusion were performed in 13 cases during primary arthrodesis, 9 cases developed degenerative changes at the proximal junction. Fifteen cases with abnormal postoperative lumbar lordosis demonstrated adjacent segment degeneration. Sixteen cases living in the countryside and 15 cases with a history of severe physical labor after the primary operation showed degenerative changes in the adjacent segment before secondary arthrodesis.

Conclusion

The causes of revision arthrodesis for the degenerative changes at the adjacent segment are believed to be preexisting degenerative changes in the adjacent segment at the proximal junction, loss of lordosis after primary fusion, and severe physical labor from living in the countryside

Keywords: Lumbosacral fusion, Adjacent segment degeneration, Revision arthrodesis

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Table 1.
Overall data in this study
N Age Sex FU (M) 1st Dx K. grade∗ 1st Op NPFL† SLA‡ DRC§ 2nd Dx RAL∗∗ R†† ROA‡‡
01 61 F 2160 SLT. L4 1 PLF 1 12 ∘ JS‖ Above Rural SPL§§
02 53 F 1340 SLT. L4   PLF 1 32   JS Above Rural MPL‖‖
03 54 F 1420 LSS. L4-S1 3 PLF 2 14 ∘ ASI Above Urban SPL
04 77 F 87 SLT. L4, L5 2 PLF 2 21 ∘ JS Below Rural SPL
05 81 F 1370 LSS. L4-S1 2 PLF 2 18 ∘ JS Above Urban SPL
06 59 F 1230 LSS. L3-5 2 PLF 2 38 ∘ JS Above Rural SPL
07 61 F 1080 LSS. L5-S1 2 PLF 1 16 ∘ JS Above Rural SPL
08 58 M 61 LSS. L1-5 4 PLF 4 05 ∘ JS Above Urban SPL
09 57 F 74 SLT. L4   PLIF 1 36   ASI Above Rural MPL
10 62 M 96 LSS. L4-5 1 PLF 1 15 ∘ JS Above Rural SPL
11 53 F 75 SLT. L4, L5   PLF 2 33   JS Above Rural SPL
12 62 M 67 LSS. L2-5 2 PLF 3 21 ∘ JS Above Urban MPL
13 71 M 61 LSS. L2-5 3 PLF 3 19 ∘ JS Above Rural SPL
14 70 F 43 LSS. L2-5 3 PLF 3 09 ∘ ASI Above Rural MPL
15 56 M 57 LSS. L4-S1   PLF 2 39   JS Above Rural SPL
16 56 M 46 SLT. L4 1 PLF 1 16 ∘ JS Above Rural SPL
17 35 M 47 LSS. L3-5 2 PLF 2 24 ∘ ASI Above Rural SPL
18 63 M 44 SLT. L4   PLIF 1 42   JS Above Rural MPL
19 64 F 39 LSS. L3-5   PLIF 2 33   ASI Above Rural SPL
20 57 F 38 SLT. L3, L4 2 PLIF 2 12 ∘ JS Above Rural SPL

∗ Kellgren grade;

† Number of primary fusion level;

‡ Segmental lordosis angle;

§ Degenerative radiologic changes;

‖ Junctional stenosis;

Adjacent segmental instability;

∗∗ Revision arthrodesis level;

†† Residency;

‡‡ Range of activity;

§§ Severe physical labor;

‖‖ Minor physical labor

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