Lumbar Fusion Adjacent Level Disease

Lumbar Fusion Adjacent Level Disease

Lumbar Fusion Adjacent Level Disease

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In the July 2004 Edition of the Journal of Bone and Joint Surgery,  Dr. Ghiselli et al performed a retrospective review on patients that had undergone lumbar fusions by primarily by the Late Dr. Edgar Dawson,  distinguished professor and spine surgeon affliated with UCLA.  The goal was to establish the rate of developing symptomatic adjacent level degeneration that required surgical management.   The journal article details the indications for the fusion procedure.  Most patients had posterior intertransverse process spinal fusion for spondylolithesis,  post-laminectomy instability,  or recurrent discectomy.  Patients excluded from the study included those with history of neoplasm, acute fracture of dislocation,  or were scheduled to have an additional anterior surgical procedure.

Total number of patients reviewed are 215 patients that have had posterior lumbar fusion between April of 1983 to August of 1994.  As we know,  the article was written in 2004.  The surgical procedures included about 50% of the patients that had non-instrumented fusion  ( no plates,  screws or other hardware).

The study concluded that 16.5% of these patients had additional decompression or fusion within 5 years.  36.1% of these patients had additional decompression or fusion within 10 years.    The theory is that these patients developed symptomatic disk degeneration that required surgery at a rate of 3.9% a year.

Of course,  while the study did present some numbers,  this was a retrospective review,  and  the multiple different indications for the primary lumbar fusion was not well stratified.  We do no know if patients that had recurrent disk herniations,  versus patients that had post-laminectomy instability versus spondylolisthesis had more or less numbers of patients with development of symptomatic adjacent level disease.  We do not know if there was a difference of outcome based on the surgical technique utilized (instrumentation,  vs non-instrumentation).   Also,  there was no matched pair of non-surgically treated patients to see if there is an statistical difference in adjacent level disease in non-surgically treated patients.    What if the adjacent level degeneration is not because of the surgery,  but rather,  because the patients who need surgery also are the ones who develop rapid degeneration that would be considered surgically treatable?  The authors themselves stated the limitation of the study is that the endpoint for symptomatic adjacent level disease is the additional surgery.  There can also be a population that develops surgically treatable adjacent level disease,  but chose not to have surgery.  There are too many unanswered questions to conclude the rates and percentages are accurate.  But,  as a spine surgeon,  we do know that adjacent level degeneration is a real issue that must be measured,  and counseling on the potential for further surgery should be discussed with all patients undergoing lumbar spinal fusion.

While some will use this data to discredit spinal fusion,  most clinicians know that spinal fusion still has a role.  Further studies will hopefully give us better information,  so we can inform patients,  families,  insurers,  etc the potential for more surgery in this population.

 

 

 

 

 

Citations

  • Wang MY, Vasudevan R, Mindea SA. Minimally invasive lateral interbody fusion for the treatment of rostral adjacent-segment lumbar degenerative stenosis without supplemental pedicle screw fixation. J Neurosurg Spine. 2014 Dec;21(6):861-6. PubMed PMID: 25303619
  • Sander AL, Lehnert T, El Saman A, Eichler K, Marzi I, Laurer H. Outcome of traumatic intervertebral disk lesions after stabilization by internal fixator. AJR Am J Roentgenol. 2014 Jul;203(1):140-5. PubMed PMID: 24951207

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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