Changes in the Adjacent Segment After Thoracolumbar Posterior Instrumentation and Fusion Surgery in Thoracolumbar Junction Fractures

TAEKEUN AHN; Dongeun Shin; 김태호; 이상준; Jun Ku Lee; Chul Gie Hong

Study design: Retrospective study. Objectives: To evaluate changes in the adjacent segment after posterior instrumentation and fusion in thoracolumbar spinal fractures. Summary of Literature Review: The incidence of adjacent-segment disease is increasing as spinal surgery becomes more common. Many studies have been conducted on the risk factors for adjacent-segment changes in the lumbar spine, but few articles have been published on this topic in the thoracolumbar spine. Material and Methods: The records of 50 patients who received treatment from 2000 to 2013 were reviewed retrospectively. They underwent posterior instrumentation and fusion due to thoracolumbar fracture and were followed up for more than 2 years. To evaluate changes in the adjacent segment, immediate postoperative and last follow-up values of the sagittal angle, disc height, and disc angle were compared between groups divided by age (more or less than 50 years), laminectomy, and fusion levels. The Pfirrmann grade of the discs proximal and distal to the fusion level was also measured using preoperative magnetic resonance imaging. Results: Thirty-six patients were male and 14 were female. The average age of the 50 patients was 45.6 years, and the mean follow-up period was 4.3 years. There were no cases of adjacent-segment disease. The mean kyphotic sagittal angle progression was 6.8° (range, −11° to 28.5°, p=0.000). The mean change of disc height of the proximal adjacent segment was 0.3 mm (range, −1.6 to 3.4 mm, p=0.013) and 0.6 mm (range, −4.1 to 5.8 mm, p=0.013) in the distal adjacent segment. Laminectomy did not make a significant difference. In the group below 50 years of age, the angle of the adjacent segment discs increased by 0.8° (range, −3.1° to 5.1°, p=0.004) at the proximal adjacent segment and by 0.5°(range, −4.8° to 2.9°, p=0.016) at the distal adjacent segment. Proximal adjacent disc height decreased as the fusion levels increased. As the preoperative Pfirrmann grade increased, degenerative changes in the proximal adjacent segment disc tended to accelerate. Conclusions: Adjacent-segment disease after lumbar fusion surgery was not found in adjacent segments of the thoracolumbar spine. This seems to be due to the anatomical characteristics of the lumbar spine, which is more flexible than the thoracolumbar vertebra. The mobile segments of the lumbar spine may account for this difference, rather than the instrumentation and fusion procedure itself.

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* 2021년 이후 발행 논문의 참고문헌은 현재 구축 중입니다.

[journal] Albee FH / 1911 / Transplantation of a portion of the tibia into the spine for pott’s disease: A preliminary report / J Am Med Assoc 57 : 885~886

[journal] Ghiselli G / 2004 / Adjacent segment degeneration in the lumbar spine / J Bone Joint Surg Am 86 : 1497~1503

[journal] Lee CK / 1984 / Lumbosacral spinal fusion. A biomechanical study / Spine (Phila Pa 1976) 9 : 574~581

[journal] Booth KC / 1999 / Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion / Spine (Phila Pa 1976) 24 : 1721~1727

[journal] Lehmann TR / 1987 / Long-term followup of lower lumbar fusion patients / Spine (Phila Pa 1976) 12 : 97~104

[journal] Penta M / 1995 / Magnetic resonance imaging assessment of disc degeneration 10 years after anterior lumbar interbody fusion / Spine (Phila Pa 1976) 20 : 743~747

[journal] Cheh G / 2007 / Adjacent segment disease followinglumbar/thoracolumbar fusion with pedicle screw instrumentation : a minimum 5-year follow-up / Spine (Phila Pa 1976) 32 : 2253~2257

[journal] Charles Malveaux WMS / 2011 / Adjacent Segment Disease After Lumbar Spinal Fusion : A Systematic Review of the Current Literature / Semin Spine Surg 23 : 266~274

[journal] Nagata H / 1993 / The effects of immobilization of long segments of the spine on the adjacent and distal facet force and lumbosacral motion / Spine (Phila Pa 1976) 18 : 2471~2479

[journal] Cunningham BW / 1997 / The effect of spinal destabilization and instrumentation on lumbar intradiscal pressure : an in vitro biomechanical analysis / Spine (Phila Pa 1976) 22 : 2655~2663

[journal] Aota Y / 1995 / Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders / J Spinal Disord 8 : 464~473

[journal] Etebar S / 1999 / Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability / J Neurosurg 90 : 163~169

[journal] Kumar MN / 2001 / Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease / Eur Spine J 10 : 309~313

[journal] Schlegel JD / 1996 / Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions / Spine (Phila Pa 1976) 21 : 970~981

[journal] Wiltse LL / 1999 / Comparative study of the incidence and severity of degenerative change in the transition zones after instrumented versus noninstrumented fusions of the lumbar spine / J Spinal Disord 12 : 27~33

[journal] 조규정 / 2009 / Proximal Adjacent Segment Disease following PosteriorInstrumentation and Fusion for Degenerative Lumbar Scoliosis / 대한정형외과학회지 / 대한정형외과학회 44(1) : 109~117

[journal] Shufflebarger H / 2006 / Debate: determining the upper instrumented vertebra in the management of adult degenerative scoliosis: stopping at T10 versus L1 / Spine (Phila Pa 1976) 31(Suppl) : 185~194

[journal] Gillet P / 2003 / The fate of the adjacent motion segments after lumbar fusion / J Spinal Disord Tech 16 : 338~345

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