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Yang, Lee, Song, Kim, and Yeon: Correlation Between Clinical Result and Adjacent Segment Degeneration After Lumbar Spinal Fusion
Original Article

Journal of Korean Spine Surg 2008;15(1):38-43.

Published online: 12 February 2008

DOI: https://doi.org/10.4184/jkss.2008.15.1.38

Correlation Between Clinical Result and Adjacent Segment Degeneration After Lumbar Spinal Fusion

Jun-Young Yang, M.D., June-Kyu Lee, M.D., Ho-Sup Song, M.D., Tae-Hoon Kim, M.D., Kyu-Woong Yeon, M.D.

Department of Orthopedic Surgery, Chungnam National University, School of medicine, Research Institute for Medical Sciences, Daejeon, Korea

Address reprint requests to Jun-Young Yang, M.D. Department of Orthopedic Surgery 640 Daesa-Dong Jung-Gu Daejeon, Korea, Tel: 82-42-280-7351, Fax: 82-42-252-7098, E-mail: jyyang@cnu.ac.kr

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

Retrospective study

Objectives

To determine the relationship between clinical outcome and adjacent segment degeneration (ASD) after lumbar fusion.

Summary of Literature Review

Few studies have analyzed the correlation between clinical outcomes and ASD.

Materials and Methods

Between January 2000 and December 2004, 217 patients who underwent lumbar spinal fusion (®2 years of follow-up) were evaluated. The patients were divided into 2 groups: one-segment (A) and two-segment (B). The UCLA grading scale was used to evaluate the prevalence of ASD on radiography. The association between clinical outcome and ASD was evaluated by Spearman's correlation.

Results

ASD occurred in 11.6% (13/112) of patients in group A and 15.2% (16/105) of patients in group B. The number of cases which progressed to more than 2 levels of the degenerative grade were 0 cases in group A and 13 cases (81.3%) in group B. In A, 5 out of 13 ASD cases downgraded one level in their clinical outcomes. In B, all 16 ASD cases downgraded more than one level in their clinical outcomes. Worsening in degenerative grade, was correlated with worse clinical outcome (Spearman's rho = 0.829, P ®0.05).

Conclusions

The association of clinical outcomes with ASD after fusion showed a significant correlation, especially association with ASD after multiple segment fusion.

Keywords: Adjacent Segmental Degeneration (ASD), Clinical outcome, Lumbar fusion

REFERENCES

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Fig. 1.
In Group A, change of degenerative grade is 1 grade in all 13 cases. In Group B, it is 2 grade in 11 cases and 3 grade in 2 case
jkss-15-38f1.tif
Fig. 2.
Correlation between the change of degenerative grade and the change of clinical outcomes show positive ratio (Spearman's rho=0.829, P<0.05).
jkss-15-38f2.tif
Table 1.
Arthritic grade for intervertebral disc degeneration.
Grade Disc-Space Narrowing Osteophytes End Plate Sclerosis
I - - -
II + - -
III ± + -
IV ± ± +

Grade is base upon the most severe radiographic finding evident on plain radiograph. Patients were rated based on the worst category satisfied. +; present, -; absence, +/-; wither present or absent

Table 2.
Clinical and radiographic results.
              Degenerative Grade Clinical Outcome
Group Case Age Sex F/U Operation Level ASD Level Preop Last F/U Change∗ Postop Last F/U Change
  11 60 M 27 L3-4 L4-5 1 2 1 Excellent Excellent 0
  12 48 F 39 L4-5 L3-4 1 2 1 Excellent Excellent 0
  13 49 M 35 L4- L3-4 1 2 1 Good Good 0
  14 63 M 38 L4-5 L3-4 2 3 1 Good Good 0
  15 63 F 60 L4-5 L3-4 2 3 1 Good Good 0
  16 57 M 59 L5-S1 L4-5 2 3 1 Good Good 0
A 17 64 F 25 L4-5 L3-4 1 2 1 Good Good 0
  18 59 F 37 L5-S1 L4-5 1 2 1 Good Good 0
  19 59 M 35 L4-5 L3-4 1 2 1 Good Fair 1
  10 51 M 26 L5-S1 L4-5 1 2 1 Excellent Good 1
  11 54 M 48 L5-S1 L4-5 2 3 1 Excellent Good 1
  12 54 F 29 L3-4 L2-3 1 2 1 Excellent Good 1
  13 61 M 29 L5-S1 L4-5 1 2 1 Good Fair 1
  11 58 M 60 L3-4-5 L2-3 2 3 1 Good Fair 1
  12 55 M 38 L2-3-4 L4-5 2 3 1 Good Fair 1
  13 61 M 38 L4-5-S1 L3-4 1 3 2 Excellent Fair 2
  14 56 M 37 L4-5-S1 L3-4 2 4 2 Good Poor 2
  15 66 F 24 L3-4-5 L2-3 1 3 2 Excellent Fair 2
  16 52 F 27 L4-5-S1 L3-4 1 3 2 Excellent Poor 3
  17 68 F 41 L3-4-5 L2-3 2 4 2 Good Fair 1
B 18 60 F 41 L4-5-S1 L3-4 2 4 2 Good Poor 2
  19 52 F 74 L4-5-S1 L3-4 1 4 3 Good Poor 2
  10 61 F 29 L2-3-4-5 L5-S1 1 2 1 Excellent Good 1
  11 50 M 30 L2-3-4-5 L1-2 1 3 2 Excellent Good 1
  12 56 M 39 L3-4-5-S1 L2-3 1 3 2 Excellent Fair 2
  13 57 M 53 L2-3-4-5 L1-2 1 3 2 Excellent Fair 2
  14 66 F 55 L2-3-4-5-S1 L1-2 2 4 2 Good Poor 2
  15 54 M 42 L2-3-4-5-S 1L1-2 1 3 2 Excellent Fair 2
  16 64 F 32 L3-4-5-S1 L2-3 1 4 3 Good Poor 2

∗ Change = (preoperative degenerative grade degenerative grade at last follow up)

® ; Change = (clinical outcome at postoperative 3 months clinical outcome at last follow up)

Table 3.
Changes of degenerative grade and clinical outcomes.
Group Numbers of Degenerative change Change of Degenerative Grade Change of Clinical outcome
    1 2 3 0 1 2 3
A 13 13 0 0 8 5 10 0
B 16 13 11 2 0 5 10 1
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