Sublaminar wiring stabilization to prevent adjacent segment degeneration after lumbar spinal fusion.
BACKGROUND
Adjacent segment degeneration (ASD) is a complication of lumbar spinal fusion. There are some reports on the cause of this degeneration but none concerning its prevention. We performed sublaminar wiring stabilization to prevent ASD after posterolateral lumbar spinal fusion with instrumentation. The purpose of this study was to prospectively evaluate the efficacy of this procedure.


METHODS
Between 2003 and 2004, 54 consecutive patients with lumbar spinal canal stenosis and multilevel instability of the lumbar spine underwent posterior decompression and posterolateral fusion with instrumentation. The mean age at the time of surgery was 66.7 +/- 1.3 years, and the mean follow-up period was 40.0 +/- 1.1 months, with a minimum of 29 months. Twenty-seven of the patients underwent conventional sublaminar wiring stabilization at the cephalad segment adjacent to the site of fusion to prevent ASD (group A), and the other 27 patients did not (group B). Some items were assessed, including clinical outcome using Japanese Orthopaedic Association (JOA) score, sagittal global lumbar alignment, and segmental motion in flexion-extension radiographs of the cephalad vertebral body adjacent to the site of fusion.


RESULTS
There were no significant differences in JOA scores between two groups, but 2 patients in group B underwent subsequent surgery due to ASD. Sagittal lumbar alignment did not change in group A but was significantly decreased in group B. With respect to segmental motion in flexion-extension radiographs, group A showed a significant decrease from 6.9 degrees before surgery to 3.4 degrees after surgery, on the other hand group B showed a significant increase from 5.6 degrees before surgery to 8.4 degrees after surgery.


CONCLUSIONS
In this study, it was suggested that sublaminar wiring stabilization significantly reduces the range of motion of the adjacent segment and preserves sagittal lumbar alignment, which lead to prevention of ASD. The clinical outcome of the subsequent surgeries is relatively poor, so it is important to prevent ASD by any prevention such as sublaminar wiring stabilization.
Ogawa
Hiroyasu
H
Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1, Yanagido, Gifu, Gifu, 501-1194, Japan. h-ogawa@k7.dion.ne.jp
Hori
Hirohiko
H
Oshita
Hidefumi
H
Akaike
Atsushi
A
Koyama
Yoshinari
Y
Shimizu
Takashi
T
Yamada
Kazunari
K
Ishimaru
Daich
D
D000368:Aged; D001864:Bone Wires; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013122:Spinal Diseases / Q000209:etiology* / Q000517:prevention & control*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D013130:Spinal Stenosis / Q000601:surgery