Surgical Management of Thoracolumbar Adjacent Segment Disease: Techniques and Outcomes in 107 Patients Undergoing Surgical Intervention.

Autor:	Bashti M; Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, FL, USA malekbashti@gmail.com., Daftari M; Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, FL, USA., Brusko GD; Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, FL, USA., Jamshidi AM; Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, FL, USA., Singh EB; Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, FL, USA., Boddu JV; Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, FL, USA., Kumar V; Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, FL, USA., Yang MMH; Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, FL, USA., Wang MY; Department of Neurosurgery, Miller School of Medicine, University of Miami, Miami, FL, USA.
Jazyk:	angličtina
Zdroj:	International journal of spine surgery [Int J Spine Surg] 2024 Jul 04; Vol. 18 (3), pp. 295-303. Date of Electronic Publication: 2024 Jul 04.
DOI:	10.14444/8599
Abstrakt:	Background: Adjacent segment disease (ASD) is a known sequela of thoracolumbar instrumented fusions. Various surgical options are available to address ASD in patients with intractable symptoms who have failed conservative measures. However, the optimal treatment strategy for symptomatic ASD has not been established. We examined several clinical outcomes utilizing different surgical interventions for symptomatic ASD. Methods: A retrospective review was performed for a consecutive series of patients undergoing revision surgery for thoracolumbar ASD between October 2011 and February 2022. Patients were treated with endoscopic decompression ( N = 17), microdiscectomy ( N = 9), lateral lumbar interbody fusion (LLIF; N = 26), or open laminectomy and fusion (LF; N = 55). The primary outcomes compared between groups were re-operation rates and numeric pain scores for leg and back at 2 weeks, 10 weeks, 6 months, and 12 months postoperation. Secondary outcomes included time to re-operation, estimated blood loss, and length of stay. Results: Of the 257 patients who underwent revision surgery for symptomatic ASD, 107 patients met inclusion criteria with a minimum of 1-year follow-up. The mean age of all patients was 67.90 ± 10.51 years. There was no statistically significant difference between groups in age, gender, preoperative American Society of Anesthesiologists scoring, number of previously fused levels, or preoperative numeric leg and back pain scores. The re-operation rates were significantly lower in LF (12.7%) and LLIF cohorts (19.2%) compared with microdiscectomy (33%) and endoscopic decompression (52.9%; P = 0.005). Only LF and LLIF cohorts experienced significantly decreased pain scores at all 4 follow-up visits (2 weeks, 10 weeks, 6 months, and 12 months; P < 0.001 and P < 0.05, respectively) relative to preoperative scores. Conclusion: Symptomatic ASD often requires treatment with revision surgery. Fusion surgeries (either stand-alone lateral interbody or posterolateral with instrumentation) were most effective and durable with respect to alleviating pain and avoiding additional revisions within the first 12 months following revision surgery. Clinical Relevance: This study emphasizes the importance of risk-stratifying patients to identify the least invasive approach that treats their symptoms and reduces the risk of future surgeries. Competing Interests: Declaration of Conflicting Interests : Michael Y. Wang discloses that he receives royalty payments from DePuy-Synthes Spine, is a consultant for DePuy-Synthes Spine, Inc., Stryker, Spineology, Surgalign, Pacira, Nuvasive, and has stock in Innovative Surgical Devices, Kinesiometrics, and Medical Device Partners. Michael M.H. Yang reports that he is a consultant for Stryker and DePuy Synthes. Malek Bashti, Manav Daftari, Damian Brusko, Aria M. Jamshidi, Eric B. Singh, V. Boddu, Vignessh Kumar, and Michael Yang have nothing to disclose. (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2024 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)
Databáze:	MEDLINE
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