Incidence of adjacent segment disease requiring reoperation after lumbar laminectomy without fusion: A study of 398 patients

Mohamad Bydon, Mohamed Macki, Rafael De La Garza-Ramos, Kelly McGovern, Daniel M. Sciubba, Jean Paul Wolinsky, Timothy F. Witham, Ziya L. Gokaslan, Ali Bydon

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

BACKGROUND: Adjacent segment disease (ASD) has not been described after lam-inectomy without fusion. OBJECTIVE: To determine the incidence of ASD after a 1- or 2-level lumbar laminectomy. METHODS: We retrospectively reviewed medical records of all patients who underwent 1- or 2-level, bilateral lumbar laminectomy without fusion for degenerative spinal disease (all follow-up ≥1 year). ASD was defined as clinical and/or radiographic evidence of degenerative spinal disease that required reoperation at the level above or below the index laminectomy. RESULTS: Of the 398 patients, the incidence of ASD requiring reoperation was 10%. The 39 ASD cases were almost equally distributed at L2-L3 (31%), L3-L4 (26%), and L5-S1 (31%), and to a lesser extent at L4-L5 (15%) (P = .51). The ASD incidences of 10% and 9% were equivalent after a 1- and 2-level laminectomy, respectively (P = .76). Rostral ASD was statistically more common than caudal ASD after both the 1- (P < .001) and 2- (P < .001) level laminectomy. Of the 39 ASD cases, 95% required laminectomy, 26% dis-cectomy, and 49% fusion. Average time to ASD was 4 years. After a Kaplan-Meier analysis, time to reoperation for ASD was equivalent among the 1- and 2-level lam-inectomy cohorts (log-rank test, P = .13). CONCLUSION: The cumulative incidence of ASD requiring reoperation was 10% over a mean of 4 years. Both the 1- and 2-level laminectomy cohorts experienced equivalent incidences and rates of ASD. Of the 39 operations for ASD, about half required a fusion.

Original languageEnglish (US)
Pages (from-to)192-198
Number of pages7
JournalClinical Neurosurgery
Volume78
Issue number2
DOIs
StatePublished - 2016
Externally publishedYes

Keywords

  • Adjacent segment degeneration
  • Adjacent segment disease
  • ASD
  • Laminectomy
  • Lumbar
  • Reoperation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Bydon, M., Macki, M., De La Garza-Ramos, R., McGovern, K., Sciubba, D. M., Wolinsky, J. P., Witham, T. F., Gokaslan, Z. L., & Bydon, A. (2016). Incidence of adjacent segment disease requiring reoperation after lumbar laminectomy without fusion: A study of 398 patients. Clinical Neurosurgery, 78(2), 192-198. https://doi.org/10.1227/NEU.0000000000001007