title: Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360 degrees fusion.
abstract: Adjacent segment degeneration (ASD) is discussed to impair long-term outcome after lumbar interbody fusion. Nevertheless the amount and origin of degeneration and its clinical relevance remain unclear. Only little data is published studying quantitative disc height reduction (DHR) as indicator for ASD in long-term follow-up. Forty patients (23 men, 17 women) (group 1: degenerative disc disease, n = 27; group 2: lytic spondylolisthesis, n = 13) underwent lumbar 360 degrees instrumentation and fusion between 1991 and 1997. Preoperative and follow-up lateral lumbar radiographs were studied. Disc heights of first and second cephalad adjacent segments were measured by Farfan's technique and Hurxthal's technique modified by Pope. Clinical outcome was studied using Oswestry disability index (ODI) and visual analogue scale (VAS). Age, gender, prior surgery, fusion rate and number of fusion levels were investigated as potential factors affecting the outcome. Mean follow-up was 114 (72-161) months. Clinical outcome showed an improvement of 44.6% in ODI and 43.8% in VAS with a tendency towards better results in group 2. Fusion rate was 95%. Disc height of the first cephalad adjacent segment in all patients was reduced by on average 21% (Farfan, P < 0.001) and 19% (Pope, P < 0.001), respectively, and that of the second adjacent level by on average 16% (Farfan, P < 0.001) and 14% (Pope, P < 0.001), respectively. A tendency towards more disc height reduction (DHR) in the degenerative group was observed. Advanced age correlated with advanced DHR (P < or = 0.003, r = 0.5). Multiple level fusion led to a more pronounced DHR than 1-level fusion (P = 0.028). There was a tendency towards more DHR in the first adjacent disc compared to the second. Gender, prior surgery of the fused segment and fusion level did not affect the amount of DHR. There was no correlation between the clinical outcome and DHR. Lumbar fusion is associated with DHR of adjacent discs. This may be induced by additional biomechanical stress, ongoing degeneration affecting the lumbar spine and advancing age. However, clinical outcome is not correlated with adjacent DHR.
authors.affiliation: Department of Orthopaedics, University Hospital Münster, Albert-Schweitzer-Strasse 33, 48149, Münster, Germany. dr.tobias.schulte@web.de
authors.forename: Tobias L
authors.initials: TL
authors.lastname: Schulte
authors.forename: Freek
authors.initials: F
authors.lastname: Leistra
authors.forename: Viola
authors.initials: V
authors.lastname: Bullmann
authors.forename: Nani
authors.initials: N
authors.lastname: Osada
authors.forename: Volker
authors.initials: V
authors.lastname: Vieth
authors.forename: Björn
authors.initials: B
authors.lastname: Marquardt
authors.forename: Thomas
authors.initials: T
authors.lastname: Lerner
authors.forename: Ulf
authors.initials: U
authors.lastname: Liljenqvist
authors.forename: Lars
authors.initials: L
authors.lastname: Hackenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects; D007403:Intervertebral Disc / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D012008:Recurrence; D013123:Spinal Fusion / Q000009:adverse effects* / Q000706:statistics & numerical data; D017211:Treatment Failure