Higher risk of adjacent segment degeneration after floating fusions: long-term outcome after low lumbar spine fusions.
METHODS
We report the long-term outcome after mono-segmental and bisegmental fusions at the lumbar L4-S1 region of the spine.


OBJECTIVE
Long-term clinical and radiologic outcome measures were used to determine a lumbar fusion's contribution to degenerative changes in adjacent motion segments (ASD).


BACKGROUND
The role of low lumbar spinal fusions and their long-term contribution to accelerated degenerative changes in the adjacent motion segments continues to be a subject of controversy.


METHODS
We followed-up 102 patients with an average age of 54 (22 to 78) years and a follow-up time of 14 (3 to 22) years.


RESULTS
Overall results in patients were good, the Oswestry-Disability Index (ODI) showed an average of 26% (0% to 70%) at follow-up, the Visual Analog Scale rose from 2.7 (postoperative) and 2.9 (12 wk follow-up) to 3.6 (latest follow-up) points, respectively. Patient satisfaction with their health-related situation at follow-up was 69% (15% to 100%). Patients who underwent fusions of the segment L5/S1 showed a significant (P<0.05) lower risk for ASD than patients with fusions L4/5 (20% vs. 46%). Compared with L4/5 fusions, bisegmental L4-S1 fusions showed a similar trend (P=0.06) with a lower risk for ASD (24%). Objective and subjective clinical results showed no differences between these groups. Patients suffering from ASD showed significant (P<0.05) reduced sacral inclination and lumbar lordosis angles and also significant (P<0.05) higher ODI values compared with non-ASD patients.


CONCLUSIONS
We conclude that floating fusions of single low lumbar segments are more likely to result in ASD and are negatively influenced by sagittal plane abnormalities.
Disch
Alexander Carl
AC
Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Germany. alexander.disch@charite.de
Schmoelz
Werner
W
Matziolis
Georg
G
Schneider
Sascha V
SV
Knop
Christian
C
Putzier
Michael
M
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000453:epidemiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012447:Sacrum / Q000473:pathology / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects* / Q000706:statistics & numerical data; D013168:Spondylolisthesis / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome