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Preoperative Risk Factors for Adjacent Segment Degeneration after Two-Level Floating Posterior Fusion at L3-L5

Authors :
Shuta Ushio
Takashi Hirai
Toshitaka Yoshii
Hiroyuki Inose
Masahito Yuasa
Shigenori Kawabata
Atsushi Okawa
Source :
Spine Surgery and Related Research, Vol 4, Iss 1, Pp 43-49 (2020)
Publication Year :
2020
Publisher :
The Japanese Society for Spine Surgery and Related Research, 2020.

Abstract

Introduction: The aims of this study were to investigate how adjacent segment degeneration (ASD) occurs at the proximal and distal segments after L3-L5 fusion surgery, namely, floating fusion, and to identify the risk factors for ASD in patients who undergo this surgery. Methods: Fifty patients who underwent floating fusion surgery at vertebrae L3-L5 and developed ASD were enrolled. The following parameters were evaluated: body mass index (BMI), diabetes status, dialysis status, lumbar lordosis, segmental lordosis between the L2 upper endplate and the L3 lower endplate, disc height, Cobb's angle, apical vertebral rotation using the Nash and Moe classification method, preoperative disc degeneration, surgical procedures, and the upper instrumented vertebra (UIV) tilt angle. The UIV tilt angle was defined as positive when the anterior side was directed caudally. Results: Twenty-two (44%) of the 50 patients showed cephalad radiographic ASD (RASD) and 5 patients (10%) showed caudad RASD. Clinically symptomatic ASD was found at L2-L3 in 4 patients (8%) and at L5-S1 in 2 patients (4%). All the patients with clinically symptomatic cephalad ASD underwent revision procedures for radiculopathy or claudication because of degenerative pathology at L3-L4. Multivariate regression analysis showed a significant association of the absolute value of UIV tilt angle (mean |UIV tilt|) with cephalad RASD (odds ratio 1.09, p = 0.038). Receiver-operating characteristic curve analysis showed a significant association of |UIV tilt| >10.3° with RASD (sensitivity 67.9%, specificity 77.3%, area under the curve [AUC] 0.675). Conclusions: RASD was more likely to occur at the adjacent segment on the cephalad side than at the adjacent segment on the caudad side after two-segment floating fusion of L3-L5. A preoperative UIV tilt angle >10° or UIV tilt < −10° was a risk factor for RASD.

Details

Language :
English
ISSN :
2432261X
Volume :
4
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Spine Surgery and Related Research
Publication Type :
Academic Journal
Accession number :
edsdoj.2c7244a55098411eba437d1eaee938fe
Document Type :
article
Full Text :
https://doi.org/10.22603/ssrr.2019-0003