Lightning Podiums: Spinal Gumbo - 803A

Presented by: J. Soh

Author(s):

J. Soh(1), J.C. Lee(2), B.-J. Shin(2)

(1) Soonchunhyang University Cheonan Hospital, Orthopaedic Surgery, Cheonan, Korea, Republic of
(2) Soonchunhyang University, Orthopaedic Surgery, Seoul, Korea, Republic of

Abstract

Purpose of the Study: It was to analyze risk factors for adjacent segment disease(ASD), by comparing patients occurred ASD with patients followed more than 10 years after lumbar spinal fusion with pedicle screw fixation for degenerative lumbar spinal disease.

Methods: From August 1988 to December 2005, 581 patients underwent lumbar spinal fusion of 3 and less segment to treat degenerative lumbar disease. Among them, 180 patients underwent revision surgery for ASD or followed more than 10 years were included in this study. Average The mean age at the initial operation was 53.6 years old and the mean follow-up period was 160.6 months. Gender, age, residence, preoperative diagnosis, fusion method, number of fused segments, whether laminectomy of adjacent segments, preoperative degree of disc degeneration of adjacent segments in MRI, wether adjacent segments included L4-5 or L5-S1, and radiological measurements were analyzed. In radiological measurement, pre-& post-operative lumbar lordotic angle(LLA), correction of LLA, post-operative fusion segment lordotic angle(FSLA) per level were estimated. Statistical univariate analysis was performed with the Chi-square test and multivariate logistic regression analysis was done by using SPSS 14.0.

Results: There were 40 patients with revision surgery due to ASD. Seven patients were operated by decompression or discectomy and 33 patients needed additional fusion. In univatiate analysis, the frequency of ASD was significantly high in cases that age was more than 65 years old(p=0.002), laminectomy of adjacent segment was performed(p=0.002), preoperative disc degeneration of adjacent segments in MRI was present(p=0.001) and post-operative FSLA per level was < 16°(p=0.024). In multivariate logistic regression analysis, the frequency of ASD was significantly high in case that age was more than 65 years old(p=0.015, odd ratio=3.106), laminectomy of adjacent segment was performed(p=0.012, odd ratio=5.044) and preoperative disc degeneration of adjacent segments in MRI was present(p=0.022, odd ratio=3.008).

Conclusions: We analyzed risk factors for ASD, by comparing patients occurred ASD with patients followed more than 10 years after lumbar spinal fusion for degenerative lumbar spinal disease. Development of ASD was affected that age was more than 65 years old at initial operation, laminectomy of adjacent segment was performed and preoperative disc degeneration of adjacent segments in MRI was present. In case of old age and patients existed preoperative degenerative change of adjacent segment, careful decision should be considered to carry out lumbar spinal fusion.