GARY GHISELLI, MD, JEFFREY C. WANG, MD, NITIN N. BHATIA, MD, WELLINGTON K. HSU, AND EDGAR G. DAWSON, MD
Two hundred and fifteen patients who had undergone posterior lumbar arthrodesis were included in the study.
Fifty-nine (27.4%) of the 215 patients had evidence of degeneration at the adjacent levels and elected to have an additional decompression (15 patients) or arthrodesis (44 patients).
The rate of symptomatic degeneration at an adjacent segment warranting either decompression or arthrodesis was predicted to be 16.5% at five years and 36.1% at ten years.
Retrospective studies on scoliosis as well as longitudinal studies on lumbar fusion have suggested that lower lumbar fusions predispose patients to problems in the adjacent motion segments.1-14
The continued degeneration of motion segments adjacent to lumbar spinal fusions is a potential concern for both patients and surgeons and accounts for a substantial percentage of revision spine surgery. Although the development of adjacent segment degeneration can be considered part of the normal aging and degenerative process, this phenomenon appears to be at least partly influenced by the altered stresses that arise as a consequence of lumbar fusion.
In the present study, the rate of surgical intervention for adjacent segment disease was 3.9% per year during the first ten years following primary posterior lumbar arthrodesis. At ten years, 36.1% of the patients would have sufficient disease to warrant additional surgical intervention.
Patients who had a multiple-level fusion were significantly less likely to have symptomatic adjacent segment disease than those who had a single-level fusion.
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