Early Adjacent Segment Degeneration after Short Lumbar Fusion (original) (raw)
Study design: Retrospective cohort study. Object: To assess the factors that may be important in the early adjacent segment disease (ASD) development after one level lumbar fusion. Summary: Today in a review of the world literature there is no consensus about the main risk factors importance for this disease, as well as the terms and conditions of its occurrence. And today there are more and more questions about the reasons for the early development of ASD in the event of a short fixation. Methods: This study evaluated 146 patients who underwent one level 360° fusion lumbar surgery for degenerative lumbar disease between 2005 and 2012. We compare 2 groups according to the presence and extent of initial degenerative changes in the adjacent upper segment. These groups were comparable in terms of main risk factors for ASD such as obesity, age, smoking, menopause, global balance disturbance. Patients in both groups had no significant differences in sex and age composition, the level of quality of life and daily physical activity. First group include 86 patients with no preexisting or 1 to 3 stage degenerative changes by Pfirrmann modified, second group include 60 patients with initial adjacent disk degenerative changes of stage 4 and above according Pfirrmann modified classification. The average follow-up period was 42.2 months (range, 28–112 months). Results: In the I group symptomatic ASD was found in 14 (16,3%) cases and ASD average development time was 35 (8-56) months. In the II group during the follow-up period 24 (40%) patients had ASD with average development time 21,5 (3-46) months. Symptomatic adjacent segment pathology was significantly more frequent in the II group (p < 0.05). The analysis of the symptomatic ASD timing has been obtained statistically significant data on the earlier development of this disease in the second group (p < 0.05). Conclusion: Patients with pre-existing degenerative changes in adjacent levels above stage 3 by Pfirrmann must be assigned to a high risk group for early ASD development even in the short lumbar fusion.
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