|Year : 2020 | Volume
| Issue : 1 | Page : 9-16
Incidence and risk factors of reoperation in patients with adjacent segment disease: A meta-analysis
Major B Burch1, Nicholas W Wiegers1, Sonal Patil2, Ali Nourbakhsh3
1 Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, MO, USA
2 Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, USA
3 Department of Orthopedic Surgery, Spine Surgery Division, Atlanta Medical Center, Atlanta, GA, USA
|Date of Submission||24-Jan-2020|
|Date of Acceptance||25-Feb-2020|
|Date of Web Publication||4-Apr-2020|
Dr. Ali Nourbakhsh
Department of Orthopedic Surgery, Spine Surgery Division, Atlanta Medical Center, Atlanta, GA
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Study Design: This was a systematic review of the literature and meta-analysis.
Objective: The objective of this study was to evaluate the current literature regarding the risk factors contributing to reoperation due to adjacent segment disease (ASD).
Summary of Background Data: ASD is a broad term referring to a variety of complications which might require reoperation. Revision spine surgery is known to be associated with poor clinical outcomes and high rate of complications. Unplanned reoperation has been suggested as a quality marker for the hospitals.
Materials and Methods: An electronic search was conducted using PubMed. A total of 2467 articles were reviewed. Of these, 55 studies met our inclusion criteria and included an aggregate of 1940 patients. Data were collected pertaining to risk factors including age, sex, fusion length, lumbar lordosis, body mass index, pelvic incidence, sacral slope, pelvis tilt, initial pathology, type of fusion procedure, floating versus sacral or pelvic fusion, presence of preoperative facet or disc degeneration at the junctional segment, and sagittal orientation of the facets at the junctional segment. Analysis of the data was performed using Comprehensive Meta-Analysis software (Biostat, Inc.).
Results: The overall pooled incidence rate of reoperation due to ASD from all included studies was 0.08 (confidence interval: 0.065–0.098). Meta-regression analysis demonstrated no significant interaction between age and reoperation rate (P = 0.48). A comparison of the event rates between males and females demonstrated no significant difference between male and female reoperation rates (P = 0.58). There was a significantly higher rate of ASD in patients with longer fusion constructs (P = 0.0001).
Conclusions: We found that 8% of patients in our included studies required reoperation due to ASD. Our analysis also revealed that longer fusion constructs correlated with a higher rate of subsequent revision surgery. Therefore, the surgeon should limit the number of fusion levels if possible to reduce the risk of future reoperation due to ASD.
Level of evidence: IV
Keywords: Adjacent segment disease, deformity, fusion, lumbar, spine, thoracic
|How to cite this article:|
Burch MB, Wiegers NW, Patil S, Nourbakhsh A. Incidence and risk factors of reoperation in patients with adjacent segment disease: A meta-analysis. J Craniovert Jun Spine 2020;11:9-16
|How to cite this URL:|
Burch MB, Wiegers NW, Patil S, Nourbakhsh A. Incidence and risk factors of reoperation in patients with adjacent segment disease: A meta-analysis. J Craniovert Jun Spine [serial online] 2020 [cited 2020 Nov 24];11:9-16. Available from: https://www.jcvjs.com/text.asp?2020/11/1/9/281900
| Introduction|| |
Posterior lumbar fusion is a widely performed procedure for treating a variety of conditions including scoliosis, spondylolisthesis, trauma, infections, or tumors. The number of patients undergoing lumbar fusion has increased significantly in the past 10–20 years. Fusion surgery for spinal deformity is the definitive intervention for the management of this condition. Spinal fusion is intended to improve a patient's quality of life by achieving a stable correction of the deformity.
Despite various improvements in the efficacy of spinal fusion procedures, postoperative complications including revisions are still a reality. The reoperation rate after spine deformity surgery has been reported to be 3.9%–25.8% in the literature.,,, Revision spine surgery is known to be associated with poor clinical outcomes, high rate of complications, and implant failures., In addition, unplanned reoperation has been suggested as a quality marker for the hospitals where spine surgeries are performed. Given the rising number of lumbar fusion procedures and new health-care policies regarding readmission and revision surgeries, spine surgeons need to be able to identify, adequately treat, and effectively decrease the risk of reoperation.
Adjacent segment disease (ASD) is a broad term referring to a variety of complications after spinal fusion including degenerative disc disease, facet arthritis, kyphosis, stenosis, compression fractures, listhesis, and instability, posterior ligamentous complex disruption, or implant failure. Proximal junctional kyphosis (PJK), regarding which there are multiple proposed definitions, serves as one of the most discussed issues arising at an adjacent segment. One of the most widely reported definitions, proposed by Glattes et al., is defined as an increased sagittal Cobb angle of 10° or more than the preoperative measurement. However, Bernhardt and Bridwell, Lee et al., Helgeson et al., Hostin et al., and O'Shaughnessy et al. have all reported differing definitions for PJK. Further complicating this issue, the interobserver reliability of measuring the proximal junctional Cobb angle has been reported to be as low as 0.55. In addition, the clinical implications of PJK can be highly variable among patients. For example, Yagi et al. did not find any difference between the Scoliosis Research Society score and the Oswestry Disability Index between PJK and non-PJK patients at a 2- and 5-year follow-up.,
The purpose of our study was to evaluate the current literature regarding the risk factors contributing to reoperation due to ASD. Regardless of the radiological findings at the proximal end of the construct, further postoperative care of the patients is mostly dependent on whether the ASD is symptomatic. In these scenarios, factors leading to presentation before revision surgery include central or neural foraminal stenosis, sagittal imbalance, and pain which can be due to implant failure or fracture. To our knowledge, this is the first meta-analysis examining the risk factors of symptomatic ASD requiring reoperation after lumbar or thoracolumbar fusion.
| Materials and Methods|| |
An electronic search was conducted using PubMed using the terms “adjacent,” “segment,” “disease,” “pathology,” “fusion,” “lumbar,” and “arthrodesis” [Figure 1]. Titles and abstracts were screened to determine which studies may be eligible for inclusion. Two of the authors were involved in the screening process (NW and AN). After the collation of these abstracts, full-length texts were reviewed and further deemed qualified after consideration of the criteria. Data pertaining to the ASD risk factors including age, sex, fusion length, lumbar lordosis (LL), body mass index (BMI), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), initial pathology, type of fusion procedure, floating versus sacral or pelvic fusion, presence of preoperative facet or disc degeneration at the junctional segment, and sagittal orientation of the facets at the junctional segment were recorded and analyzed using Microsoft Excel (Redmond, WA). No funding source was utilized for this study.
|Figure 1: PRISMA flowchart showing the review of literature and selection process of the eligible studies|
Click here to view
We included studies that were (1) either retrospective or prospective, (2) published in English, (3) referred to lumbar or thoracolumbar spinal fusion either with or without the use of instrumentation, and (4) reported data regarding ASD requiring repeat surgical intervention in the whole group or subgroup of patients. Data regarding the reoperation rate and ASD risk factors were reported. We excluded studies that (1) examined procedures that may impact outcomes of patients with ASD (such as dynamic stabilization), (2) studies without clear report of at least one of the aforementioned risk factors or the rate of ASD reoperation, (3) studies that did not report the data and results clearly, (4) biomechanical studies, (5) case studies, and (6) systematic reviews. A risk assessment summary based on the PRISMA protocol is provided in supplemental material.
The collected information from studies was imported into Comprehensive Meta-Analysis software (Biostat, Inc., Englewood, NJ, USA). We assessed whether there were enough eligible studies, and therefore statistical power, to examine each risk factor to be included in the analyses. Meta-regression or ANOVA was used for analysis. P < 0.05 was considered significant for all analysis and P < 0.10 was considered significant for Q-statistic.
Models were synthesized using random-effects model meta-analysis methods. We calculated the weighted pooled event rates of reoperation. A random-effects model was chosen due to variation among the individual studies' patient populations and surgical methods. The mean prevalence was calculated with a 95% confidence interval (CI). Heterogeneity was assessed using Q-statistic and I2 tests. To study the interaction of risk factors with prevalence of reoperation rates, we conducted an analysis using meta-regression for continuous variables. We conducted subgroup analyses using ANOVA for categorical variables. Funnel plot and Egger's regression were used to assess publication bias.
| Results|| |
Fifty-five studies,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, with a total of 1940 participants met our inclusion criteria [Figure 1]. The average follow-up was 6.4 years. Reported surgical indications included instability, radiculopathy, cauda equina, imbalance, and back pain. The pooled incidence rate of reoperation due to ASD was 0.08, meaning that about 8% of the patients from all studies who underwent spinal fusion surgery required reoperation due to ASD. The CI for the rate of reoperation was 0.065–0.098, which reveals that the mean rates of reoperation in the universe of studies could fall anywhere in this range.
The observed effect size varies somewhat among the included studies, which is to be expected due to sampling error. We need to determine if the observed variation falls within the range that can be attributed to sampling error (in which case there is no evidence of variation in true effects) or if it exceeds that range. The Q-statistic provides a test of the null hypothesis that all studies in the analysis share a common effect size. The Q value is 573.820 with 54° of freedom and P < 0.001. We can reject the null hypothesis that the reoperation rate is the same in all these studies. The I2-statistic reveals what proportion of the observed variance reflects differences in true effect sizes rather than sampling error. Here, I2 is 90.589. This reveals that about 90% of the variance in observed rates reflects variance in true rates rather than sampling error [Figure 2].
|Figure 2: The reoperation rate due to adjacent segment disease in different studies|
Click here to view
Since we have significant heterogeneity of event rates, we calculated the prediction interval to determine which was from 0.019 to 0.387.
Age (mean age of participants with ASD, not the mean age of sample): Meta-regression: No significant interaction between age and reoperation event rates (P = 0.48) based on 17 studies that reported mean of participants needing reoperation for ASD [Figure 3].
Sixteen studies reported reoperation event rates by sex. For females, the pooled event rate is 0.079 with a CI of 0.060–0.104. For males, the pooled event rate is 0.088 with a CI of 0.065–0.119. The between-group comparison of the two event rates (0.079 vs. 0.088) resulted in a P value of 0.4. Hence, there is no significant difference in event rates between male and female subgroups [Figure 4].
Fusion length (mean fusion length of participants with ASD, not of total sample): Meta-regression analysis from 25 studies showed an interaction between event rates and fusion length with a significant P = 0.0001 [Figure 5].
Subgroup analysis of participants showed no significant difference in reoperation rates between participants who underwent fusion procedures extending or not extending to the sacrum/pelvis (floating and sacral procedures) where the P value of Q-statistic was 0.6. No valid conclusion could be made for BMI (3 studies), PI (5 studies), initial pathology (14 pathologies reported), and fusion procedures (8 procedures reported) since some pathologies and fusion procedures were reported in only 1–2 studies and subgroup analysis could not be performed. No other significant risk factors were identified based on the number of studies needed for a valid statistical analysis (LL, SS, PT, presence of preoperative facet or disc degeneration at the junctional segment, and sagittal orientation of the facets at the junctional segment).
| Discussion|| |
A recent study of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database showed that the annual number of spinal fusion in the US increased from 174,223 to 413,171 in 10 years (from 1998 to 2008). Unplanned revision surgeries further increase health-care costs by increasing operating room utilization, lengthening surgical waiting list, and result in longer hospital stays. These procedures can also negatively affect staff trust and self-confidence. It is important to know risk factors for revision surgery as a guide for implementing preventative measures. ASD is the cause of revision surgery after spinal fusion. The present study reviewed the current literature to identify risk factors for reoperation on ASD.
There is much discrepancy among authors regarding the definition of ASD. For example, Cheh et al. reported almost 30% incidence of ASD in their cohorts. They mentioned that the high rate of ASD in their study was due to their generous definition of ASD. In the current study, we focused on the clinical implications of ASD. We examined the current literature to evaluate what factor (s) affect the clinical outcomes of the patients after lumbar or thoracolumbar fusion procedures which required subsequent revision. Our study is designed to focus on the reoperation rate and risk factors of ASD rather than just radiological findings. As previously mentioned, radiological findings may not correlate with the clinical symptoms of the patient and therefore much be examined in context with the patient's clinical presentation. In a study by Abraham et al. on 217 patients, the incidence of radiological and clinical ASD was reported to be 29% and 18%, respectively. They reported the incidence of reoperation to be 9%.
There is a great deal of controversy over the pathophysiology of ASD in the literature. While some biomechanical studies have shown increased stress at the facet joints of L4–L5 and L3–L4 after lumbosacral fusion, other studies have shown hypermobility in the segments next to the fused segments., Further biomechanical studies have shown a shift in the center of rotation leading to increased stress over the facet and disc of the adjacent segment.
Based on our analysis of the current literature, the length of the fusion is the most important risk factor for reoperation due to ASD. Liu et al. performed a literature review to evaluate the risk factors of radiographic PJK as defined by Glattes et al. Those risk factors included surgery at the age of 55 years or older, fusion to S1, T5–T12 >40°, low bone mineral density, and sagittal vertical axis difference >5 cm. Other risk factors include larger preoperative thoracic kyphosis, larger immediate postoperative thoracic kyphosis correction, male sex, thoracoplasty, use of pedicle screw on top of the construct, and fusion to lumbar levels below L2.,
It has also been argued that ASD is a normal degenerative process,, which can also happen after lumbar discectomies. Bydon et al. reported a 4% incidence of ASD requiring return to the operating room during a period of just over 3 years after lumbar discectomy on a cohort of 751 patients. Some preventative measures have been proposed based on the risk factors of ASD. These include preservation of the facet capsule and posterior ligamentous complex, use of hooks instead of pedicle screws, and vertebroplasty at the upper instrumented vertebrae.
Based on our study, the length of the fusion construct is the most important risk factor impacting the risk for revision surgery due to ASD. Therefore, surgeons should seek to limit the number of fusion levels as much as possible so as to minimize the future development of ASD and subsequent need for reoperation. This may be potentially be achieved by stopping a fusion at a distal thoracic level in deformity surgeries in the absence of significant thoracic kyphosis and osteopenia or stopping at L4 in the absence of radiculopathy from the fractional curve.
In conclusion, we reviewed the current literature to evaluate risk factors for revision spinal surgery due to ASD. We focused on the clinical implications of ASD rather than radiographic findings alone. Since the length of fusion construct was the most important risk factor contributing to revision surgeries, our recommendation is to minimize the number of the fusion segments whenever possible during these procedures. Limitations of this study include the inherent selection bias present in meta-analyses, the high heterogeneity of current data, and small sample sizes of primary studies evaluating ASD. Further research could shed additional light on this issue but would likely require large, prospective data collection pertaining to patients undergoing primary spinal fusion procedures with extensive and well-structured postoperative follow-up. Due to the cost, longitudinal nature, and need for a high patient volume required for such an analysis, a study of this nature would benefit from a multi-institution collaboration.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bydon M, Xu R, Santiago-Dieppa D, Macki M, Sciubba DM, Wolinsky JP, et al
. Adjacent-segment disease in 511 cases of posterolateral instrumented lumbar arthrodesis: Floating fusion versus distal construct including the sacrum. J Neurosurg Spine 2014;20:380-6.
Liang CZ, Li FC, Li H, Tao Y, Zhou X, Chen Q ×. Surgery is an effective and reasonable treatment for degenerative scoliosis: A systematic review. J Int Med Res 2012;40:399-405.
Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D, Study Group on Scoliosis. Complications and risk factors of primary adult scoliosis surgery: A multicenter study of 306 patients. Spine (Phila Pa 1976) 2012;37:693-700.
Ramo BA, Richards BS. Repeat surgical interventions following “definitive” instrumentation and fusion for idiopathic scoliosis: Five-year update on a previously published cohort. Spine (Phila Pa 1976) 2012;37:1211-7.
Sponseller PD. Pediatric revision spinal deformity surgery: Issues and complications. Spine (Phila Pa 1976) 2010;35:2205-10.
Richards BS, Hasley BP, Casey VF. Repeat surgical interventions following “definitive” instrumentation and fusion for idiopathic scoliosis. Spine (Phila Pa 1976) 2006;31:3018-26.
Pichelmann MA, Lenke LG, Bridwell KH, Good CR, O'Leary PT, Sides BA. Revision rates following primary adult spinal deformity surgery: Six hundred forty-three consecutive patients followed-up to twenty-two years postoperative. Spine (Phila Pa 1976) 2010;35:219-26.
Campos M, Dolan L, Weinstein S. Unanticipated revision surgery in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2012;37:1048-53.
Lehman RA Jr. Postoperative lymphocele after revision circumferential long-segment scoliosis construct for pseudarthrosis. Spine J 2011;11:684-5.
McSorley S, Lowndes C, Sharma P, Macdonald A. Unplanned reoperation within 30 days of surgery for colorectal cancer in NHS Lanarkshire. Colorectal Dis 2013;15:689-94.
Virk SS, Niedermeier S, Yu E, Khan SN. Adjacent segment disease. Orthopedics 2014;37:547-55.
Glattes RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A, Edwards C 2nd
. Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: Incidence, outcomes, and risk factor analysis. Spine (Phila Pa 1976) 2005;30:1643-9.
Bernhardt M, Bridwell KH. Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine (Phila Pa 1976) 1989;14:717-21.
Lee GA, Betz RR, Clements DH 3rd
, Huss GK. Proximal kyphosis after posterior spinal fusion in patients with idiopathic scoliosis. Spine (Phila Pa 1976) 1999;24:795-9.
Helgeson MD, Shah SA, Newton PO, Clements DH 3rd
, Betz RR, Marks MC, et al
. Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation. Spine (Phila Pa 1976) 2010;35:177-81.
Hostin R, McCarthy I, O'Brien M, Bess S, Line B, Boachie-Adjei O, et al
. Incidence, mode, and location of acute proximal junctional failures after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976) 2013;38:1008-15.
O'Shaughnessy BA, Bridwell KH, Lenke LG, Cho W, Baldus C, Chang MS, et al
. Does a long-fusion “T3-sacrum” portend a worse outcome than a short-fusion “T10-sacrum” in primary surgery for adult scoliosis? Spine (Phila Pa 1976) 2012;37:884-90.
Sacramento-Domínguez C, Vayas-Díez R, Coll-Mesa L, Parrilla AP, Machado-Calvo M, Pinilla JA, et al
. Reproducibility measuring the angle of proximal junctional kyphosis using the first or the second vertebra above the upper instrumented vertebrae in patients surgically treated for scoliosis. Spine (Phila Pa 1976) 2009;34:2787-91.
Yagi M, Akilah KB, Boachie-Adjei O. Incidence, risk factors and classification of proximal junctional kyphosis: Surgical outcomes review of adult idiopathic scoliosis. Spine (Phila Pa 1976) 2011;36:E60-8.
Yagi M, King AB, Boachie-Adjei O. Incidence, risk factors, and natural course of proximal junctional kyphosis: Surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years of follow-up. Spine (Phila Pa 1976) 2012;37:1479-89.
Lipsey M. Identifying interesting variables and analysis opportunities. In: Cooper H, Hedges L, Valentine J, editors. The Handbook of Research Synthesis and Meta-analysis. New York: Russell Sage Foundation; 2009. p. 147-58.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-60.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-34.
Abraham EP, Manson NA, McKeon MD. The incidence of adjacent segment breakdown in polysegmental thoracolumbar fusions of three or more levels with minimum 5-year follow-up. Global Spine J 2014;4:83-8.
Ahn DK, Park HS, Choi DJ, Kim KS, Yang SJ. Survival and prognostic analysis of adjacent segments after spinal fusion. Clin Orthop Surg 2010;2:140-7.
Aiki H, Ohwada O, Kobayashi H, Hayakawa M, Kawaguchi S, Takebayashi T, et al
. Adjacent segment stenosis after lumbar fusion requiring second operation. J Orthop Sci 2005;10:490-5.
Alentado VJ, Lubelski D, Healy AT, Orr RD, Steinmetz MP, Benzel EC, et al
. Predisposing characteristics of adjacent segment disease after lumbar fusion. Spine (Phila Pa 1976) 2016;41:1167-72.
Anandjiwala J, Seo JY, Ha KY, Oh IS, Shin DC. Adjacent segment degeneration after instrumented posterolateral lumbar fusion: A prospective cohort study with a minimum five-year follow-up. Eur Spine J 2011;20:1951-60.
Baioni A, Di Silvestre M, Greggi T, Vommaro F, Lolli F, Scarale A. Does hybrid fixation prevent junctional disease after posterior fusion for degenerative lumbar disorders? A minimum 5-year follow-up study. Eur Spine J 2015;24 Suppl 7:855-64.
Booth KC, Bridwell KH, Eisenberg BA, Baldus CR, Lenke LG. Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion. Spine (Phila Pa 1976) 1999;24:1721-7.
Cho KS, Kang SG, Yoo DS, Huh PW, Kim DS, Lee SB. Risk factors and surgical treatment for symptomatic adjacent segment degeneration after lumbar spine fusion. J Korean Neurosurg Soc 2009;46:425-30.
Choi KC, Kim JS, Shim HK, Ahn Y, Lee SH. Changes in the adjacent segment 10 years after anterior lumbar interbody fusion for low-grade isthmic spondylolisthesis. Clin Orthop Relat Res 2014;472:1845-54.
Disch AC, Schmoelz W, Matziolis G, Schneider SV, Knop C, Putzier M. Higher risk of adjacent segment degeneration after floating fusions: Long-term outcome after low lumbar spine fusions. J Spinal Disord Tech 2008;21:79-85.
Epstein NE. Low reoperation rate following 336 multilevel lumbar laminectomies with noninstrumented fusions. Surg Neurol Int 2016;7:S331-6.
] [Full text]
Ghasemi AA. Adjacent segment degeneration after posterior lumbar fusion: An analysis of possible risk factors. Clin Neurol Neurosurg 2016;143:15-8.
Ghiselli G, Wang JC, Bhatia NN, Hsu WK, Dawson EG. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am 2004;86:1497-503.
Gillet P. The fate of the adjacent motion segments after lumbar fusion. J Spinal Disord Tech 2003;16:338-45.
Ha KY, Son JM, Im JH, Oh IS. Risk factors for adjacent segment degeneration after surgical correction of degenerative lumbar scoliosis. Indian J Orthop 2013;47:346-51. [Full text]
Ha KY, Kim YH, Ahn JH. Is it real adjacent segment pathology by stress concentration after limited fusion in degenerative lumbar scoliosis? Spine (Phila Pa 1976) 2014;39:1059-66.
Heo Y, Park JH, Seong HY, Lee YS, Jeon SR, Rhim SC, et al
. Symptomatic adjacent segment degeneration at the L3-4 level after fusion surgery at the L4-5 level: Evaluation of the risk factors and 10-year incidence. Eur Spine J 2015;24:2474-80.
Hikata T, Kamata M, Furukawa M. Risk factors for adjacent segment disease after posterior lumbar interbody fusion and efficacy of simultaneous decompression surgery for symptomatic adjacent segment disease. J Spinal Disord Tech 2014;27:70-5.
Horsting PP, Pavlov PW, Jacobs WC, Obradov-Rajic M, de Kleuver M. Good functional outcome and adjacent segment disc quality 10 years after single-level anterior lumbar interbody fusion with posterior fixation. Global Spine J 2012;2:21-6.
Hyun SJ, Kim YB, Hong HJ, Kwon JT, Suk JS, Min BK. Predictable risk factors for adjacent segment degeneration after lumbar fusion. J Korean Neurosurg Soc 2007;41:88-94.
Kaito T, Hosono N, Mukai Y, Makino T, Fuji T, Yonenobu K. Induction of early degeneration of the adjacent segment after posterior lumbar interbody fusion by excessive distraction of lumbar disc space. J Neurosurg Spine 2010;12:671-9.
Kanayama M, Togawa D, Hashimoto T, Shigenobu K, Oha F. Motion-preserving surgery can prevent early breakdown of adjacent segments: Comparison of posterior dynamic stabilization with spinal fusion. J Spinal Disord Tech 2009;22:463-7.
Kim TH, Lee BH, Moon SH, Lee SH, Lee HM. Comparison of adjacent segment degeneration after successful posterolateral fusion with unilateral or bilateral pedicle screw instrumentation: A minimum 10-year follow-up. Spine J 2013;13:1208-16.
Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 2001;10:314-9.
Lee DY, Jung TG, Lee SH. Single-level instrumented mini-open transforaminal lumbar interbody fusion in elderly patients. J Neurosurg Spine 2008;9:137-44.
Lee CS, Hwang CJ, Lee SW, Ahn YJ, Kim YT, Lee DH, et al
. Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J 2009;18:1637-43.
Lee M, Yang HJ, Lee SH, Park SB. Outcomes of instrumented posterolateral fusion for patients over 70 years with degenerative lumbar spinal disease: A minimum of 2 years follow-up. Korean J Spine 2012;9:74-8.
Lee JC, Kim Y, Soh JW, Shin BJ. Risk factors of adjacent segment disease requiring surgery after lumbar spinal fusion: Comparison of posterior lumbar interbody fusion and posterolateral fusion. Spine (Phila Pa 1976) 2014;39:E339-45.
Lee YS, Kim YB, Park SW. Survival rates and risk factors for cephalad and L5-s1 adjacent segment degeneration after L5 floating lumbar fusion: A minimum 2-year follow-up. J Korean Neurosurg Soc 2015;57:108-13.
Liu H, Wu W, Li Y, Liu J, Yang K, Chen Y. Protective effects of preserving the posterior complex on the development of adjacent-segment degeneration after lumbar fusion: Clinical article. J Neurosurg Spine 2013;19:201-6.
Maruenda JI, Barrios C, Garibo F, Maruenda B. Adjacent segment degeneration and revision surgery after circumferential lumbar fusion: outcomes throughout 15 years of follow-up. Eur Spine J 2016;25:1550-7.
Min JH, Jang JS, Lee SH. Comparison of anterior- and posterior-approach instrumented lumbar interbody fusion for spondylolisthesis. J Neurosurg Spine 2007;7:21-6.
Nakashima H, Kawakami N, Tsuji T, Ohara T, Suzuki Y, Saito T, et al
. Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: Based on Cases With a Minimum of 10 Years of Follow-up. Spine (Phila Pa 1976) 2015;40:E831-41.
Ogawa H, Hori H, Oshita H, Akaike A, Koyama Y, Shimizu T, et al
. Sublaminar wiring stabilization to prevent adjacent segment degeneration after lumbar spinal fusion. Arch Orthop Trauma Surg 2009;129:873-8.
Okuda S, Miyauchi A, Oda T, Haku T, Yamamoto T, Iwasaki M. Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. J Neurosurg Spine 2006;4:304-9.
Otsuki B, Fujibayashi S, Takemoto M, Kimura H, Shimizu T, Matsuda S. Diffuse idiopathic skeletal hyperostosis (DISH) is a risk factor for further surgery in short-segment lumbar interbody fusion. Eur Spine J 2015;24:2514-9.
Ou CY, Lee TC, Lee TH, Huang YH. Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine disease. Neurosurgery 2015;76:396-401.
Radcliff K, Curry P, Hilibrand A, Kepler C, Lurie J, Zhao W, et al
. Risk for adjacent segment and same segment reoperation after surgery for lumbar stenosis: A subgroup analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976) 2013;38:531-9.
Radcliff KE, Kepler CK, Maaieh M, Anderson DG, Rihn J, Albert T, et al
. What is the rate of lumbar adjacent segment disease after percutaneous versus open fusion? Orthop Surg 2014;6:118-20.
de la Garza-Ramos R, Kerezoudis P, Sciubba DM, Bydon A, Witham TF, Bydon M. The effect of preoperative diagnosis on the incidence of adjacent segment disease after lumbar fusion. J Neurosurg Sci 2018;62:4-9.
Sakaura H, Yamashita T, Miwa T, Ohzono K, Ohwada T. Symptomatic adjacent segment pathology after posterior lumbar interbody fusion for adult low-grade isthmic spondylolisthesis. Global Spine J 2013;3:219-24.
Scemama C, Magrino B, Gillet P, Guigui P. Risk of adjacent-segment disease requiring surgery after short lumbar fusion: Results of the French Spine Surgery Society Series. J Neurosurg Spine 2016;25:46-51.
Sears WR, Sergides IG, Kazemi N, Smith M, White GJ, Osburg B. Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis. Spine J 2011;11:11-20.
Shin MH, Ryu KS, Kim IS, Park CK. Symptomatic adjacent segment degeneration following posterior lumbar arthrodesis: Retrospective analysis of 6 patients experienced in 10-year of periods. J Korean Neurosurg Soc 2007;42:184-90.
Soh J, Lee JC, Shin BJ. Analysis of risk factors for adjacent segment degeneration occurring more than 5 years after fusion with pedicle screw fixation for degenerative lumbar spine. Asian Spine J 2013;7:273-81.
Tsuji T, Watanabe K, Hosogane N, Fujita N, Ishii K, Chiba K, et al
. Risk factors of radiological adjacent disc degeneration with lumbar interbody fusion for degenerative spondylolisthesis. J Orthop Sci 2016;21:133-7.
Wai EK, Santos ER, Morcom RA, Fraser RD. Magnetic resonance imaging 20 years after anterior lumbar interbody fusion. Spine (Phila Pa 1976) 2006;31:1952-6.
Yamasaki K, Hoshino M, Omori K, Igarashi H, Nemoto Y, Tsuruta T, et al
. Risk factors of adjacent segment disease after transforaminal inter-body fusion for degenerative lumbar disease. Spine (Phila Pa 1976) 2017;42:E86-E92.
Yee TJ, Terman SW, La Marca F, Park P. Comparison of adjacent segment disease after minimally invasive or open transforaminal lumbar interbody fusion. J Clin Neurosci 2014;21:1796-801.
Yugué I, Okada S, Masuda M, Ueta T, Maeda T, Shiba K. Risk factors for adjacent segment pathology requiring additional surgery after single-level spinal fusion: Impact of pre-existing spinal stenosis demonstrated by preoperative myelography. Eur Spine J 2016;25:1542-9.
Zencica P, Chaloupka R, Hladíková J, Krbec M. Adjacent segment degeneration after lumbosacral fusion in spondylolisthesis: A retrospective radiological and clinical analysis. Acta Chir Orthop Traumatol Cech 2010;77:124-30.
Zhong ZM, Deviren V, Tay B, Burch S, Berven SH. Adjacent segment disease after instrumented fusion for adult lumbar spondylolisthesis: Incidence and risk factors. Clin Neurol Neurosurg 2017;156:29-34.
Ghiselli G, Wang JC, Hsu WK, Dawson EG. L5-S1 segment survivorship and clinical outcome analysis after L4-L5 isolated fusion. Spine (Phila Pa 1976) 2003;28:1275-80.
He B, Yan L, Guo H, Liu T, Wang X, Hao D. The difference in superior adjacent segment pathology after lumbar posterolateral fusion by using 2 different pedicle screw insertion techniques in 9-year minimum follow-up. Spine (Phila Pa 1976) 2014;39:1093-8.
Rajaee SS, Bae HW, Kanim LE, Delamarter RB. Spinal fusion in the United States: Analysis of trends from 1998 to 2008. Spine (Phila Pa 1976) 2012;37:67-76.
Fröschl U, Sengstbratl M, Huber J, Függer R. Unplanned reoperations for infection complications: A survey for quality control. Surg Infect (Larchmt) 2006;7:263-8.
Li Z, Shen J, Qiu G, Yu H, Wang Y, Zhang J, et al
. Unplanned reoperation within 30 days of fusion surgery for spinal deformity. PLoS One 2014;9:e87172.
Cheh G, Bridwell KH, Lenke LG, Buchowski JM, Daubs MD, Kim Y, et al
. Adjacent segment disease followinglumbar/thoracolumbar fusion with pedicle screw instrumentation: A minimum 5-year follow-up. Spine (Phila Pa 1976) 2007;32:2253-7.
Axelsson P, Johnsson R, Strömqvist B, Arvidsson M, Herrlin K. Posterolateral lumbar fusion. Outcome of 71 consecutive operations after 4 (2-7) years. Acta Orthop Scand 1994;65:309-14.
Lee CK, Langrana NA. Lumbosacral spinal fusion. A biomechanical study. Spine (Phila Pa 1976) 1984;9:574-81.
Kim YJ, Lenke LG, Bridwell KH, Kim J, Cho SK, Cheh G, et al
. Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3 different types of posterior segmental spinal instrumentation and fusions: Incidence and risk factor analysis of 410 cases. Spine (Phila Pa 1976) 2007;32:2731-8.
Wang J, Zhao Y, Shen B, Wang C, Li M. Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis. Injury 2010;41:415-20.
Van Horn JR, Bohnen LM. The development of discopathy in lumbar discs adjacent to a lumbar anterior interbody spondylodesis. A retrospective matched-pair study with a postoperative follow-up of 16 years. Acta Orthop Belg 1992;58:280-6.
Seitsalo S, Schlenzka D, Poussa M, Osterman K. Disc degeneration in young patients with isthmic spondylolisthesis treated operatively or conservatively: A long-term follow-up. Eur Spine J 1997;6:393-7.
Penta M, Sandhu A, Fraser RD. Magnetic resonance imaging assessment of disc degeneration 10 years after anterior lumbar interbody fusion. Spine (Phila Pa 1976) 1995;20:743-7.
Bydon M, Macki M, Kerezoudis P, Sciubba DM, Wolinsky JP, Witham TF, et al
. The incidence of adjacent segment disease after lumbar discectomy: A study of 751 patients. J Clin Neurosci 2017;35:42-6.
Cho SK, Shin JI, Kim YJ. Proximal junctional kyphosis following adult spinal deformity surgery. Eur Spine J 2014;23:2726-36.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]