Operative treatment of the degenerated segment adjacent to a lumbar fusion.
Fourteen patients with a previous lumbosacral fusion underwent neural decompression and fusion of degenerated adjacent motion segment. The most common level was L3-L4, and there was an average of 3.2 (range 1-7) previous lumbosacral surgical procedures. The average interval from the first fusion until operative intervention on the degenerated adjacent segment was 11.5 years (range 3-29 years). Five patients had an uninstrumented fusion, of which only one progressed to arthrodesis. Three of these five patients with pseudarthrosis after uninstrumented fusion--and the remaining nine patients--had fusions with instrumentation. Ten of twelve instrumented fusions progressed to solid arthrodesis. The pseudoarthrosis rate of 80% was decreased to 17% with the use of supplemental instrumentation. There was a significant number of complications and poor results, especially in patients with advanced osteoporosis and those with a short interval between adjacent segment degeneration, respectively. Eleven of 14 patients reported some postoperative pain relief.
Whitecloud
T S
TS
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
Davis
J M
JM
Olive
P M
PM
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D013123:Spinal Fusion; D013997:Time Factors