Could the Topping-Off Technique Be the Preventive Strategy against Adjacent Segment Disease after Pedicle Screw-Based Fusion in Lumbar Degenerative Diseases? A Systematic Review.
The "topping-off" technique is a new concept applying dynamic or less rigid fixation such as hybrid stabilization device (HSD) or interspinous process device (IPD) for the purpose of avoiding adjacent segment disease (ASD) proximal to the fusion construct. A systematic review of the literature was performed on the effect of topping-off techniques to prevent or decrease the occurrence of ASD after lumbar fusion surgery. We searched through major online databases, PubMed and MEDLINE, using key words related to "topping-off" technique. We reviewed the surgical results of "topping-off" techniques with either HSD or IPD, including the incidence of ASD at two proximal adjacent levels (index and supra-adjacent level) as compared to the fusion alone group. The results showed that the fusion alone group had statistically higher incidence of radiographic (52.6%) and symptomatic (11.6%) ASD at the index level as well as higher incidence (8.1%) of revision surgery. Besides, the HSD (10.5%) and fusion groups (24.7%) had statistically higher incidences of radiographic ASD at supra-adjacent level than the IPD (1%). The findings suggest that the "topping-off" technique may potentially decrease the occurrence of ASD at the proximal motion segments. However, higher quality prospective randomized trials are required prior to wide clinical application.
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Po-Hsin
PH
Chou
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Hsi-Hsien
HH
Lin
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Howard S
HS
An
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Kang-Ying
KY
Liu
Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheung Kung University, Tainan, Taiwan.
Wei-Ren
0000-0002-6133-3584
WR
Su
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA; Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheung Kung University, Tainan, Taiwan.
Cheng-Li
0000-0002-7315-7709
CL
Lin
D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D065289:Pedicle Screws; D011183:Postoperative Complications / Q000517:prevention & control*; D013123:Spinal Fusion / Q000379:methods*