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KMID : 0361620070420040453
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Journal of the Korean Orthopaedic Association
2007 Volume.42 No. 4 p.453 ~ p.460
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Progression of Preoperative Degeneration of the Adjacent Segment after Instrumented Lumbar Arthrodesis
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Cho Kyu-Jung
Park Seung-Rim
Moon Kyoung-Ho
Lee Kang-Yoon
Kim Kyung-Hoon
Kang Seok-Bong
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Abstract
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Purpose: Preoperative degeneration has not been clearly defined as a risk factor of adjacent segment disease (ASD). The aim of this study was to analyze the progression of preoperative degeneration at the adjacent segment after instrumented lumbar fusion.
Materials and Methods: Forty-eight patients (mean age: 63.9, range: 39-77) who underwent posterolateral fusion for a degenerative lumbar spine were reviewed. All the patients showed preoperative degenerative changes at the adjacent segment. The preoperative degeneration included disc degeneration (n=42), degenerative lumbar scoliosis (n=7), posterior translation (n=7), lateral translation (n=9), and spondylolisthesis (n=1). The patients were divided into the following three
groups according to the progression of degeneration: Group I, No progression; Group II, asymptomatic radiographic progression; and Group III, symptomatic progression.
Results: There were 22, 15, and 11 patients in Groups I, II and III, respectively. The incidence of symptomatic progression of degeneration was 22.9%. Of the 42 patients showing disc degeneration, 9 patients (21.4%) developed symptomatic progression. On the other hand, 3 out of 7 (42.9%) patients with posterior translation and 5 out of 7 (71.4%) patients with degenerative scoliosis developed symptomatic progression. The age and number of fused segments were not predisposing factors to progression.
Conclusion: The incidence of symptomatic adjacent segment disease in patients with preoperative
degeneration was 22.9%. Preoperative coronal malalignment and posterior translation might be risk factors for adjacent segment disease. Correct selection of the fusion level is important for reducing the incidence of adjacent segment disease.
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KEYWORD
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Degeneration, Adjacent segment disease, Lumbar fusion
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