Lumbar Motion Segment Pathology Adjacent to Thoracolumbar, Lumbar, and Lumbosacral Fusions

Study Design Fifty‐eight patients came to two spinal surgeons with abnormalities adjacent to a previously fused thoracic or lumbosacral segment after they had been asymptomatic for more than 2 years. Radiographs, outcome analysis, analog pain evaluation, patient demographics, and medical indices were analyzed to evaluate risk factors for adjacent segment abnormality. Objectives Risk factors for adjacent segment breakdown and pathophysiology of adjacent segment breakdown were analyzed in this longitudinal study. Summary of Background Data Fifty‐eight patients underwent a thoracolumbar, lumbar, or lumbosacral fusion with an average symptom‐free period of 13.1 years before presentation with severe symptomatology necessitating further surgery at the adjacent segment. Methods Fifty‐eight patients with adjacent segment abnormality were analyzed by outcome assessment questionnaire, pain analog evaluation, radiographic studies, demographic factors, and sequential follow‐up evaluation. Thirty‐seven of these patients have been followed for more than 2 years after their adjacent segment surgery. Results Fifty‐eight patients developed spinal stenosis, disc herniation, or instability at a segment adjacent to a previously asymptomatic fusion that was done an average of 13.1 years earlier. Segments adjacent to the adjacent segment itself were as likely to breakdown (58%). Thirty‐seven patients were followed for more than 2 years, having outcomes defined as good or excellent in 70.3%. Seven of the 37 patients required an additional surgical procedure. Sagittal and coronal imbalances appeared to play a role in breakdown, although statistical significance was not evident. Conclusions This represents the largest series of adjacent segment breakdowns reported in the literature. The segment adjacent to the adjacent segment was almost as likely to breakdown. Sagittal and coronal alignment appeared to play a role in adjacent abnormality. Good outcomes are evident in 70% of cases.

[1]  C. Anderson.  Spondyloschisis following spine fusion. , 1956, The Journal of bone and joint surgery. American volume.

[2]  J. Cassidy,et al.  Radiologic Diagnosis of Degenerative Lumbar Spinal Instability , 1985, Spine.

[3]  J. Haselkorn,et al.  Patient outcomes after lumbar spinal fusions. , 1992, JAMA.

[4]  J W Frymoyer,et al.  A Comparison of Radiographic Findings in Fusion and Nonfusion Patients Ten or More Years Following Lumbar Disc Surgery , 1979, Spine.

[5]  W. Kirkaldy-Willis,et al.  Pathology and Pathogenesis of Lumbar Spondylosis and Stenosis , 1978, Spine.

[6]  J. Frymoyer,et al.  Disc Excision and Spine Fusion in the Management of Lumbar Disc Disease: A Minimum Ten-Year Followup , 1978, Spine.

[7]  J. Lubicky,et al.  The natural history of spondylolysis and spondylolisthesis. , 1984, The Journal of bone and joint surgery. American volume.

[8]  J. Weinstein,et al.  Long-term Follow-up of Lower Lumbar Fusion Patients , 1987, Spine.

[9]  Jackson Rk,et al.  Lateral mass fusion. A prospective study of a consecutive series with long-term follow-up. , 1985 .

[10]  H N Herkowitz,et al.  Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. , 1991, The Journal of bone and joint surgery. American volume.

[11]  E. Kirwan,et al.  The long-term results of fusion in situ for severe spondylolisthesis. , 1983, The Journal of bone and joint surgery. British volume.

[12]  P. R. Harrington,et al.  Results of Harrington instrumentation and fusion in the adult idiopathic scoliosis patient. , 1975, The Journal of bone and joint surgery. American volume.

[13]  CASEY K. LEE,et al.  Accelerated Degeneration of the Segment Adjacent to a Lumbar Fusion , 1988, Spine.

[14]  J W Frymoyer,et al.  Segmental Motion and Instability , 1987, Spine.

[15]  Frymoyer Jw,et al.  Segmental instability. Rationale for treatment. , 1985 .

[16]  J. Lonstein,et al.  Operative treatment of spinal deformities in patients with cerebral palsy or mental retardation. An analysis of one hundred and seven cases. , 1983, The Journal of bone and joint surgery. American volume.

[17]  Farfan Hf,et al.  The relation of facet orientation to intervertebral disc failure. , 1967, Canadian journal of surgery. Journal canadien de chirurgie.

[18]  C. G. Hutter.  Posterior intervertebral body fusion. A 25-year study. , 1983, Clinical orthopaedics and related research.

[19]  Michel Cr,et al.  Late results of Harrington's operation. Long-term evolution of the lumbar spine below the fused segments. , 1985 .

[20]  S Gracovetsky,et al.  The Nature of Instability , 1984, Spine.

[21]  K. Kaneda,et al.  Follow-up study of medial facetectomies and posterolateral fusion with instrumentation in unstable degenerative spondylolisthesis. , 1986, Clinical orthopaedics and related research.

[22]  R. Harris,et al.  ACQUIRED SPONDYLOLYSIS AS A SEQUEL TO SPINE FUSION. , 1963, The Journal of bone and joint surgery. American volume.

[23]  H. Farfan,et al.  Instability of the lumbar spine. , 1982, Clinical orthopaedics and related research.

[24]  W H Kirkaldy-Willis,et al.  Lumbar spinal stenosis. , 1974, Clinical orthopaedics and related research.

[25]  A. Brodsky.  Post-laminectomy and post-fusion stenosis of the lumbar spine. , 1976, Clinical orthopaedics and related research.

[26]  M. Dekutoski,et al.  Spinal mobility and deformity after Harrington rod stabilization and limited arthrodesis of thoracolumbar fractures. , 1993, The Journal of bone and joint surgery. American volume.

[27]  R. Delamarter,et al.  Late neurological complications of Harrington-rod instrumentation. , 1989, The Journal of bone and joint surgery. American volume.

[28]  H. Stockdale,et al.  Some Experimental Observations of the Influence of a Single Lumbar Floating Fusion on the Remaining Lumbar Spine , 1981, Spine.

[29]  Long-Term Anatomic and Functional Changes in Patients with Adolescent Idiopathic Scoliosis Treated by Harrington Rod Fusion , 1983, Spine.

[30]  W. G. Hardy,et al.  Results of operative treatment of protruded and ruptured lumbar discs based on 1176 operative cases with 82 per cent follow-up of 3 to 13 years. , 1961, Journal of neurosurgery.