Adjacent-segment disease in 511 cases of posterolateral instrumented lumbar arthrodesis

Floating fusion versus distal construct including the sacrum: Clinical article

Mohamad Bydon, Risheng Xu, David Santiago-Dieppa, Mohamed Macki, Daniel M. Sciubba, Jean Paul Wolinsky, Ali Bydon, Ziya L. Gokaslan, Timothy F. Witham

Research output: Contribution to journalArticle

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Abstract

Object. The aim of this study was to study the long-term outcomes of patients undergoing instrumented posterior fusion of the lumbar spine. Methods. The authors present 511 patients who underwent instrumented arthrodesis for lumbar degenerative disease over a 23-year period at a single institution. Patients underwent follow-up for an average of 39.73 ± 46.52 months (± SD) after the index lumbar arthrodesis procedure. Results. The average patient age was 59.45 ± 13.48 years. Of the 511 patients, 502 (98.24%) presented with back pain, 379 (74.17%) with radiculopathy, 76 (14.87%) with motor weakness, and 32 (6.26%) with preoperative bowel/bladder dysfunction. An average of 2.04 ± 1.03 spinal levels were fused. Postoperatively, patients experienced a significant improvement in back pain (p < 0.0001) and radiculopathy (p < 0.0001). Patients with fusions excluding the sacrum (floating fusions) were statistically more likely to develop adjacent-segment disease (ASD) than those with fusion constructs ending at S-1 distally (p = 0.030) but were less likely to develop postoperative radiculopathy (p = 0.030). In the floating fusion cohort, 31 (12.11%) of 256 patients had cephalad ASD, whereas 39 (15.29%) of 255 patients in the lumbosacral cohort had cephalad ASD development; this was not statistically different (p = 0.295). This suggests that caudad ASD development in the floating fusion cohort is due to the added risk of an unfused L5-S1 vertebral level. Because of the elevated risk of symptomatic radiculopathy but lower risk of ASD, patients in the lumbosacral fusion cohort had a reoperation rate similar to those undergoing floating fusions (p = 0.769). Conclusions. In this paper, the authors present one of the largest cohorts in the Western literature of patients undergoing instrumented fusion for degenerative lumbar spine disease. Patients who had floating lumbar fusions were statistically more likely to develop ASD over time than those who had lumbosacral fusions incorporating the S-1 spinal segment, but were less likely to experience postoperative radicular symptoms. Additional prospective studies may more clearly delineate the long-term risks of instrumented posterolateral fusions of the lumbar spine.

Original languageEnglish (US)
Pages (from-to)380-386
Number of pages7
JournalJournal of Neurosurgery: Spine
Volume20
Issue number4
DOIs
StatePublished - 2014
Externally publishedYes

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Sacrum
Arthrodesis
Radiculopathy
Spine
Back Pain
Reoperation
Urinary Bladder

Keywords

  • Adjacent-segment disease
  • Arthrodesis
  • Back pain
  • Floating lumbar fusion
  • Instrumented fusion
  • Lumbar spine
  • Surgery

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Adjacent-segment disease in 511 cases of posterolateral instrumented lumbar arthrodesis : Floating fusion versus distal construct including the sacrum: Clinical article. / Bydon, Mohamad; Xu, Risheng; Santiago-Dieppa, David; Macki, Mohamed; Sciubba, Daniel M.; Wolinsky, Jean Paul; Bydon, Ali; Gokaslan, Ziya L.; Witham, Timothy F.

In: Journal of Neurosurgery: Spine, Vol. 20, No. 4, 2014, p. 380-386.

Research output: Contribution to journalArticle

Bydon, Mohamad ; Xu, Risheng ; Santiago-Dieppa, David ; Macki, Mohamed ; Sciubba, Daniel M. ; Wolinsky, Jean Paul ; Bydon, Ali ; Gokaslan, Ziya L. ; Witham, Timothy F. / Adjacent-segment disease in 511 cases of posterolateral instrumented lumbar arthrodesis : Floating fusion versus distal construct including the sacrum: Clinical article. In: Journal of Neurosurgery: Spine. 2014 ; Vol. 20, No. 4. pp. 380-386.
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abstract = "Object. The aim of this study was to study the long-term outcomes of patients undergoing instrumented posterior fusion of the lumbar spine. Methods. The authors present 511 patients who underwent instrumented arthrodesis for lumbar degenerative disease over a 23-year period at a single institution. Patients underwent follow-up for an average of 39.73 ± 46.52 months (± SD) after the index lumbar arthrodesis procedure. Results. The average patient age was 59.45 ± 13.48 years. Of the 511 patients, 502 (98.24{\%}) presented with back pain, 379 (74.17{\%}) with radiculopathy, 76 (14.87{\%}) with motor weakness, and 32 (6.26{\%}) with preoperative bowel/bladder dysfunction. An average of 2.04 ± 1.03 spinal levels were fused. Postoperatively, patients experienced a significant improvement in back pain (p < 0.0001) and radiculopathy (p < 0.0001). Patients with fusions excluding the sacrum (floating fusions) were statistically more likely to develop adjacent-segment disease (ASD) than those with fusion constructs ending at S-1 distally (p = 0.030) but were less likely to develop postoperative radiculopathy (p = 0.030). In the floating fusion cohort, 31 (12.11{\%}) of 256 patients had cephalad ASD, whereas 39 (15.29{\%}) of 255 patients in the lumbosacral cohort had cephalad ASD development; this was not statistically different (p = 0.295). This suggests that caudad ASD development in the floating fusion cohort is due to the added risk of an unfused L5-S1 vertebral level. Because of the elevated risk of symptomatic radiculopathy but lower risk of ASD, patients in the lumbosacral fusion cohort had a reoperation rate similar to those undergoing floating fusions (p = 0.769). Conclusions. In this paper, the authors present one of the largest cohorts in the Western literature of patients undergoing instrumented fusion for degenerative lumbar spine disease. Patients who had floating lumbar fusions were statistically more likely to develop ASD over time than those who had lumbosacral fusions incorporating the S-1 spinal segment, but were less likely to experience postoperative radicular symptoms. Additional prospective studies may more clearly delineate the long-term risks of instrumented posterolateral fusions of the lumbar spine.",
keywords = "Adjacent-segment disease, Arthrodesis, Back pain, Floating lumbar fusion, Instrumented fusion, Lumbar spine, Surgery",
author = "Mohamad Bydon and Risheng Xu and David Santiago-Dieppa and Mohamed Macki and Sciubba, {Daniel M.} and Wolinsky, {Jean Paul} and Ali Bydon and Gokaslan, {Ziya L.} and Witham, {Timothy F.}",
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T1 - Adjacent-segment disease in 511 cases of posterolateral instrumented lumbar arthrodesis

T2 - Floating fusion versus distal construct including the sacrum: Clinical article

AU - Bydon, Mohamad

AU - Xu, Risheng

AU - Santiago-Dieppa, David

AU - Macki, Mohamed

AU - Sciubba, Daniel M.

AU - Wolinsky, Jean Paul

AU - Bydon, Ali

AU - Gokaslan, Ziya L.

AU - Witham, Timothy F.

PY - 2014

Y1 - 2014

N2 - Object. The aim of this study was to study the long-term outcomes of patients undergoing instrumented posterior fusion of the lumbar spine. Methods. The authors present 511 patients who underwent instrumented arthrodesis for lumbar degenerative disease over a 23-year period at a single institution. Patients underwent follow-up for an average of 39.73 ± 46.52 months (± SD) after the index lumbar arthrodesis procedure. Results. The average patient age was 59.45 ± 13.48 years. Of the 511 patients, 502 (98.24%) presented with back pain, 379 (74.17%) with radiculopathy, 76 (14.87%) with motor weakness, and 32 (6.26%) with preoperative bowel/bladder dysfunction. An average of 2.04 ± 1.03 spinal levels were fused. Postoperatively, patients experienced a significant improvement in back pain (p < 0.0001) and radiculopathy (p < 0.0001). Patients with fusions excluding the sacrum (floating fusions) were statistically more likely to develop adjacent-segment disease (ASD) than those with fusion constructs ending at S-1 distally (p = 0.030) but were less likely to develop postoperative radiculopathy (p = 0.030). In the floating fusion cohort, 31 (12.11%) of 256 patients had cephalad ASD, whereas 39 (15.29%) of 255 patients in the lumbosacral cohort had cephalad ASD development; this was not statistically different (p = 0.295). This suggests that caudad ASD development in the floating fusion cohort is due to the added risk of an unfused L5-S1 vertebral level. Because of the elevated risk of symptomatic radiculopathy but lower risk of ASD, patients in the lumbosacral fusion cohort had a reoperation rate similar to those undergoing floating fusions (p = 0.769). Conclusions. In this paper, the authors present one of the largest cohorts in the Western literature of patients undergoing instrumented fusion for degenerative lumbar spine disease. Patients who had floating lumbar fusions were statistically more likely to develop ASD over time than those who had lumbosacral fusions incorporating the S-1 spinal segment, but were less likely to experience postoperative radicular symptoms. Additional prospective studies may more clearly delineate the long-term risks of instrumented posterolateral fusions of the lumbar spine.

AB - Object. The aim of this study was to study the long-term outcomes of patients undergoing instrumented posterior fusion of the lumbar spine. Methods. The authors present 511 patients who underwent instrumented arthrodesis for lumbar degenerative disease over a 23-year period at a single institution. Patients underwent follow-up for an average of 39.73 ± 46.52 months (± SD) after the index lumbar arthrodesis procedure. Results. The average patient age was 59.45 ± 13.48 years. Of the 511 patients, 502 (98.24%) presented with back pain, 379 (74.17%) with radiculopathy, 76 (14.87%) with motor weakness, and 32 (6.26%) with preoperative bowel/bladder dysfunction. An average of 2.04 ± 1.03 spinal levels were fused. Postoperatively, patients experienced a significant improvement in back pain (p < 0.0001) and radiculopathy (p < 0.0001). Patients with fusions excluding the sacrum (floating fusions) were statistically more likely to develop adjacent-segment disease (ASD) than those with fusion constructs ending at S-1 distally (p = 0.030) but were less likely to develop postoperative radiculopathy (p = 0.030). In the floating fusion cohort, 31 (12.11%) of 256 patients had cephalad ASD, whereas 39 (15.29%) of 255 patients in the lumbosacral cohort had cephalad ASD development; this was not statistically different (p = 0.295). This suggests that caudad ASD development in the floating fusion cohort is due to the added risk of an unfused L5-S1 vertebral level. Because of the elevated risk of symptomatic radiculopathy but lower risk of ASD, patients in the lumbosacral fusion cohort had a reoperation rate similar to those undergoing floating fusions (p = 0.769). Conclusions. In this paper, the authors present one of the largest cohorts in the Western literature of patients undergoing instrumented fusion for degenerative lumbar spine disease. Patients who had floating lumbar fusions were statistically more likely to develop ASD over time than those who had lumbosacral fusions incorporating the S-1 spinal segment, but were less likely to experience postoperative radicular symptoms. Additional prospective studies may more clearly delineate the long-term risks of instrumented posterolateral fusions of the lumbar spine.

KW - Adjacent-segment disease

KW - Arthrodesis

KW - Back pain

KW - Floating lumbar fusion

KW - Instrumented fusion

KW - Lumbar spine

KW - Surgery

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