TY - JOUR
T1 - Risk factors for adjacent segment pathology requiring additional surgery after single-level spinal fusion
T2 - impact of pre-existing spinal stenosis demonstrated by preoperative myelography
AU - Yugué, Itaru
AU - Okada, Seiji
AU - Masuda, Muneaki
AU - Ueta, Takayoshi
AU - Maeda, Takeshi
AU - Shiba, Keiichiro
N1 - Publisher Copyright:
© 2015, Springer-Verlag Berlin Heidelberg.
Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Purpose: We determined the incidence of and risk factors for clinical adjacent segment pathology (C-ASP) requiring additional surgeries among patients previously treated with one-segment lumbar decompression and fusion surgery. Methods: We retrospectively analysed 161 consecutive patients who underwent one-segment lumbar decompression and fusion surgery for L4 degenerative spondylolisthesis. Patient age, sex, body mass index (BMI), facet orientation and tropism, laminar inclination angle, spinal canal stenosis ratio [on myelography and magnetic resonance imaging (MRI)], preoperative adjacent segment instability, arthrodesis type, pseudarthrosis, segmental lordosis at L4–5, and the present L4 slip were evaluated by a log-rank test using the Kaplan–Meier method. A multivariate Cox proportional-hazards model was used to analyse all factors found significant by the log-rank test. Results: Of 161 patients, 22 patients (13.7 %) had additional surgeries at cranial segments located adjacent to the index surgery’s location. Pre-existing canal stenosis ≥47 % at the adjacent segment on myelography, greater facet tropism, and high BMI were significant risk factors for C-ASP. The estimated incidences at 10 years postoperatively for each of these factors were 51.3, 39.6, and 32.5 %, and the risks for C-ASP were 4.9, 3.7, and, 3.1 times higher than their counterparts, respectively. Notably, spinal canal stenosis on myelography, but not on MRI, was found to be a significant risk factor for C-ASP (log-rank test P < 0.0001 and 0.299, respectively). Conclusions: Pre-existing spinal stenosis, greater facet tropism, and higher BMI significantly increased C-ASP risk. Myelography is a more accurate method for detecting latent spinal canal stenosis as a risk factor for C-ASP.
AB - Purpose: We determined the incidence of and risk factors for clinical adjacent segment pathology (C-ASP) requiring additional surgeries among patients previously treated with one-segment lumbar decompression and fusion surgery. Methods: We retrospectively analysed 161 consecutive patients who underwent one-segment lumbar decompression and fusion surgery for L4 degenerative spondylolisthesis. Patient age, sex, body mass index (BMI), facet orientation and tropism, laminar inclination angle, spinal canal stenosis ratio [on myelography and magnetic resonance imaging (MRI)], preoperative adjacent segment instability, arthrodesis type, pseudarthrosis, segmental lordosis at L4–5, and the present L4 slip were evaluated by a log-rank test using the Kaplan–Meier method. A multivariate Cox proportional-hazards model was used to analyse all factors found significant by the log-rank test. Results: Of 161 patients, 22 patients (13.7 %) had additional surgeries at cranial segments located adjacent to the index surgery’s location. Pre-existing canal stenosis ≥47 % at the adjacent segment on myelography, greater facet tropism, and high BMI were significant risk factors for C-ASP. The estimated incidences at 10 years postoperatively for each of these factors were 51.3, 39.6, and 32.5 %, and the risks for C-ASP were 4.9, 3.7, and, 3.1 times higher than their counterparts, respectively. Notably, spinal canal stenosis on myelography, but not on MRI, was found to be a significant risk factor for C-ASP (log-rank test P < 0.0001 and 0.299, respectively). Conclusions: Pre-existing spinal stenosis, greater facet tropism, and higher BMI significantly increased C-ASP risk. Myelography is a more accurate method for detecting latent spinal canal stenosis as a risk factor for C-ASP.
UR - http://www.scopus.com/inward/record.url?scp=84939214576&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84939214576&partnerID=8YFLogxK
U2 - 10.1007/s00586-015-4185-6
DO - 10.1007/s00586-015-4185-6
M3 - Article
C2 - 26272373
AN - SCOPUS:84939214576
SN - 0940-6719
VL - 25
SP - 1542
EP - 1549
JO - European Spine Journal
JF - European Spine Journal
IS - 5
ER -