Update on Adjacent Segment Degeneration

Update on Adjacent Segment Degeneration

Update on Adjacent Segment Degeneration

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There remains considerable controversy on the nature of Adjacent Segment Degeneration after lumbar fusion.  To the non-spine surgeons,  the issue is the theory that a fusion operation places more stress on the levels above or below the fusion,  and will lead to accelerated degeneration and subsequent surgery.  In fact,  most surgeons will tell patients about the risk for potential future surgery after lumbar fusion.

The skeptic will say the surgeon is just setting up a biase towards future surgery.   Some will say lumbar fusions are not great surgery,  and the rate of future surgery is so great that the primary lumbar spine fusion surgery should be avoided.   Several studies have showed a rate of additional future lumbar spine surgery after fusion at 10-15% over 10 years in the US population.  Spine surgeons like me,  need some guidance,  so we can appropriately discuss the effects of lumbar spinal fusion,  and the potential for increasing back pain,  and subsequent surgery after the fusion.

Recently,  there has been much interest in the so called Minimally Invasive Spine Surgery (MIS),  and potential benefits of this approach in lumbar fusions.  The major advantage,  according to the researchers on MIS is the sparing of the lumbar multifidus muscle.  It turns out the multifidus is probably the main stabilizing muscle of the spine,  and preservation may indeed also prevent the development of the Adjacent Segment Degeneration associated with lumbar fusion.

The most relevant study regarding was recently published in the August 1, 2014 Spine,  was the ISSLS Prize Winner and is titled “Long Term Follow-up Suggests Spinal Fusion is Associated With Increased Adjacent Segment Disc Degeneration But without Influence on Clinical Outcome: Results of a Combined Follow-up from 4 Randomized Control Trials” and authored by Anne F. Mannion, PhD, et al.     To summarize,  four sites,  representing locations in the United Kingdom,  Norway and Sweden followed patients for an average of 13 years randomized to surgery or non-surgery for painful lumbar disk degeneration.   Pre-operative x-rays were obtained.  The patients themselves had chronic LBP for more than a year,  with the suspected cause of the pain secondary to degenerative disk disease.   Inclusion criteria for the randomization included the use of several disability scales including the Oswestry Disability Index. Long term followup was obtained in 272 fusion patients,  and 92 non-surgical patients.   The results of the comparison of fusion vs non-fusion is another topic.  This paper looked a the effects of fusions on development of Adjacent Segment Degeneration.

X-rays were compared between the groups.  In both groups,  there was development of disk space narrowing.  In other words,  with or without surgery,  both groups had degeneration of the disks that were compared.  The study also showed the disk narrowing of the surgical patients were of a great magnitude.   But after statistical analysis,  there were no evidence that the increased degeneration associated with the fusion patients led to any difference in clinical outcomes.   In otherwords,  the difference in the amount of degeneration between the fusion,  and non surgery group did not cause any more disability or back pain.  Based on the prospective nature of this study,  I can conclude that adjacent Segment degeneration after spine surgery does not lead to more surgery secondary to the fusion.  This may or may not be what Surgeons want to counsel,  but it looks like it is the truth.  Based on latest research,  Surgeons can say  Spine Surgery is always a possibility for any spine patient, but the need for additional surgery  most likely is not related to a prior Lumbar Fusion.

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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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