Adjacent Segment Pathology After Short-Segment Posterior Lumbar Fusion: Postfusion Acceleration of Degeneration or Pre-Existing Degeneration?

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2025-02-14 DOI:10.1097/BSD.0000000000001762

Fielding Horne, Mara Louis Atherton, Rouzbeh Motiei-Langroudi

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Abstract

Study design: Retrospective review of 363 patients who underwent posterior lumbar fusion (PLF).

Objective: Adjacent segment pathology (ASP) is a major and common event in patients who have undergone PLF. The objective of this study is to determine if ASP is due to accelerated processes following fusion or to pre-existing degeneration.

Summary of background data: ASP is defined as degenerative changes that occur 1-2 levels above or below the site of fusion in patients. The etiology of ASP is a topic of debate.

Methods: Preoperative MRIs of 363 individuals who underwent PLF within L2-L3, L3-L4, and L4-L5 at the University of Kentucky between 2010 and 2020 were assessed for evidence of pre-existing degeneration. Measures of degeneration included Pfirrmann grade, modified Pfirrmann grade, disc height, and facet hyperintensity width. Demographic measures, including age, sex, smoking status, and BMI were also assessed.

Results: Throughout the follow-up period, 30.0% of patients evaluated were found to have ASP. 83.7% of these happened at the level below and 16.3% happened at the level above the fusion. Paired sample t testing indicated that only disc height was significantly different in the adjacent levels in those who developed ASP. There was no significant difference between the 2 levels for Pfirrmann grade, modified Pfirrmann grade, and facet T2 hyperintensity. Among degenerative measures, only disc height was different (lower) in the level below PLF compared with above, before fusion. Age, sex, and smoking status were not significantly different between those who developed ASP and those who did not (P=0.68, 0.81, 0.23, respectively).

Conclusions: Analysis suggests that in patients undergoing PLF, pre-existing degeneration plays an insignificant role in the development of ASP, and that postoperative acceleration of degenerative changes still represents the primary etiology of ASP.

Level of evidence: Level III.

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.