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KMID : 1001920150570020108
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Journal of Korean Neurosurgical Society
2015 Volume.57 No. 2 p.108 ~ p.113
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Survival Rates and Risk Factors for Cephalad and L5?S1 Adjacent Segment Degeneration after L5 Floating Lumbar Fusion : A Minimum 2-Year Follow-Up
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Lee Young-Seok
Kim Young-Baeg
Park Seung-Won
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Abstract
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Objective: Although the L5?S1 has distinct structural features in comparison with other lumbar spine segments, not much is known about adjacent segment degeneration (ASD) at the L5?S1 segment. The aim of study was to compare the incidence and character of ASD of the cephalad and L5?S1 segments after L5 floating lumbar fusion.
Methods: From 2005 to 2010, 115 patients who underwent L5 floating lumber fusion were investigated. The mean follow-up period was 46.1 months. The incidence of radiological and clinical ASD of the cephalad and the L5?S1 segments was compared using survival analysis. Risk factors affecting ASD were analyzed using a log rank test and the Cox proportional hazard model.
Results: Radiological ASD of the L5?S1 segment had a statistically significant higher survival rate than that of the cephalad segment (p=0.001). However, clinical ASD of the L5?S1 segment was significantly lower survival rates than that of the cephalad segment (p=0.038). Risk factor analysis showed that disc degeneration of the cephalad segment and preoperative spinal stenosis of the L5?S1 segment were risk factors.
Conclusion: In L5 floating fusion, radiological ASD was more common in the cephalad segment and clinical ASD was more common in the L5?S1 segment. At the L5?S1 segment, the degree of spinal stenosis appears to be the most influential risk factor in ASD incidences, unlike the cephalad segment.
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KEYWORD
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Radiological adjacent segment degeneration, Clinical adjacent segment degeneration, Cephalad segment, L5?S1 segment
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