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Abstract
Objectives
We analyzed the risk factors and relevance of lumbar lordosis on the incidence of adjacent segment disease after posterior lumbar interbody fusion.
Summary of Literature Review
Maintaining lumbar sagittal balance is important for decreasing the incidence of adjacent segment disease after posterior lumbar interbody fusion.
Materials and Methods
Among the patients who had undergone posterior lumbar interbody fusion of 1 or 2 levels between August 2001 and October 2008, we analyzed 153 patients who were available for at least three years of followup; among the subjects, 115 were males and 38 were females. Mean age among the patients at the time of initial surgery was 60.3 (range, 41-82) and mean followup period was 5.6 years (range, 3-11). The causative diseases were spinal stenosis in 78 cases, degenerative spondylolisthesis in 51 cases, isthmic spondylolisthesis in 23 cases, and degenerative disc disease in 1 case. At last followup, there were 52 cases (33.9%) of adjacent segment disease. Among them were found 21 cases (40.4%) of disc degeneration, 17 cases (32.7%) of instability, and 14 cases (26.9%) of simultaneous disc degeneration and instability. A total of 10 patients (6.5%) underwent a revision operation, and the mean period from initial to revision operation was 5.5 years (range, 3.1-10.3). We analyzed the correlation between risk factors of adjacent segment disease and the incidence of the disease depending on the gap between lumbar lordosis and pelvic incidence, and compared the clinical results of the 2 groups using modified Whitecloud classification.
Results
The incidence of adjacent segment disease was not statistically significant for patient age, sex, BMD, degree of obesity, causative disease, and the level of previous surgery. However, the incidence of adjacent segment disease was statistically higher in patients who had more than 9 degrees gap between lumbar lordosis and pelvic incidence (p=0.013). In our analysis of clinical results, 63.5% of the group of patients who developed adjacent segment disease and 80.2% of the group without adjacent segment disease had good or satisfactory results (p=0.031).
REFERENCES
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Figures and Tables%
Fig. 1.
(A) Initial diagnosis was degenerative spondylolisthesis L3-4-5. (B) PLIF was done L3-4-5. In whole spine standing radiograph at postoperative 3 months, lumbar lordosis (LL) was 40.8°, pelvic incidence (PI) was 52.2° (discrepancy=11.4°). (C) At postoperative 3.9 years, ASD was developed at L2-3. (D) PLIF extension was done.
Table 1.
Arthritis Grade for Intervertebral Disc Degeneration (UCLA Classification)11)
| Grade | Disc space narrowing | Osteophytes | End plate sclerosis |
|---|---|---|---|
| I | - | - | - |
| II | + | - | - |
| III | ± | + | - |
| IV | ± | ± | + |
Table 2.
Criteria for Assessing the Clinical Outcome2)
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