title: Additional decompression at adjacent segments leads to adjacent segment degeneration after PLIF.
abstract: OBJECTIVE
  Adjacent segment degeneration (ASD) is one of the major complications of lumbar fusion. Several previous retrospective studies reported ASD after PLIF. However, few reports evaluated whether decompression surgery combined with fusion surgery increases the rate of complications in adjacent segments. The purpose of the current study was to investigate the degeneration in decompressed adjacent segments after PLIF.
  
  
  METHODS
  A total of 23 patients (12 men, 11 women; average age, 58.6) who underwent PLIF surgery [1 level (n = 9), 2 levels (n = 8), 3 levels (n = 4), 4 levels (n = 2)] were included. Additional adjacent decompression above or below the level of interbody fusion was performed at 25 levels and no adjacent decompression was performed at 15 levels. We retrospectively investigated ASD by X-ray films of all 40 adjacent segments (above and below fusion level) and clinical outcomes of all 23 cases.
  
  
  RESULTS
  Of the 40 adjacent segments, 19 (47.5%) showed ASD and 9 (22.5%) showed symptomatic ASD. In the 19 segments with ASD, ASD occurred in 16 of 25 (64.0%) segments at decompressed sites compared with 3 of 15 (20.0%) non-decompressed sites. The ratio of ASD in adjacent segments was significantly higher at decompressed sites than at non-decompressed sites (p < 0.01).
  
  
  CONCLUSIONS
  ASD occurs frequently in association with additional decompression above or below the level of PLIF. In cases in which the adjacent segments require decompression, a surgical strategy that preserves as much of the posterior complex as possible should be selected.
authors: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. masayuki008@aol.com
authors: Masayuki
authors: M
authors: Miyagi
authors: Osamu
authors: O
authors: Ikeda
authors: Seiji
authors: S
authors: Ohtori
authors: Yoshikazu
authors: Y
authors: Tsuneizumi
authors: Yukio
authors: Y
authors: Someya
authors: Masataka
authors: M
authors: Shibayama
authors: Yasufumi
authors: Y
authors: Ogawa
authors: Gen
authors: G
authors: Inoue
authors: Sumihisa
authors: S
authors: Orita
authors: Yawara
authors: Y
authors: Eguchi
authors: Hiroto
authors: H
authors: Kamoda
authors: Gen
authors: G
authors: Arai
authors: Tetsuhiro
authors: T
authors: Ishikawa
authors: Yasuchika
authors: Y
authors: Aoki
authors: Tomoaki
authors: T
authors: Toyone
authors: Toshio
authors: T
authors: Ooi
authors: Kazuhisa
authors: K
authors: Takahashi
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000453:epidemiology / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013130:Spinal Stenosis / Q000601:surgery; D016896:Treatment Outcome
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