Incidence of Adjacent Segment Disease Requiring Reoperation After Lumbar Laminectomy Without Fusion
| Autor: | Timothy F. Witham, Daniel M. Sciubba, Kelly McGovern, Mohamad Bydon, Rafael De la Garza-Ramos, Ali Bydon, Jean Paul Wolinsky, Mohamed Macki, Ziya L. Gokaslan |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty medicine.medical_treatment Lumbar vertebrae Spinal disease Cohort Studies 03 medical and health sciences 0302 clinical medicine Lumbar Discectomy medicine Humans Cumulative incidence Aged Retrospective Studies 030222 orthopedics Lumbar Vertebrae business.industry Incidence Laminectomy Retrospective cohort study Middle Aged medicine.disease Surgery Spinal Fusion medicine.anatomical_structure Second-Look Surgery Anesthesia Spinal fusion Female Spinal Diseases Neurology (clinical) business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Neurosurgery. 78:192-199 |
| ISSN: | 0148-396X |
| Popis: | BACKGROUND Adjacent segment disease (ASD) has not been described after laminectomy without fusion. OBJECTIVE To determine the incidence of ASD after a 1- or 2-level lumbar laminectomy. METHODS We retrospectively reviewed medical records of all patients who underwent 1- or 2-level, bilateral lumbar laminectomy without fusion for degenerative spinal disease (all follow-up ≥1 year). ASD was defined as clinical and/or radiographic evidence of degenerative spinal disease that required reoperation at the level above or below the index laminectomy. RESULTS Of the 398 patients, the incidence of ASD requiring reoperation was 10%. The 39 ASD cases were almost equally distributed at L2-L3 (31%), L3-L4 (26%), and L5-S1 (31%), and to a lesser extent at L4-L5 (15%) (P = .51). The ASD incidences of 10% and 9% were equivalent after a 1- and 2-level laminectomy, respectively (P = .76). Rostral ASD was statistically more common than caudal ASD after both the 1- (P < .001) and 2- (P < .001) level laminectomy. Of the 39 ASD cases, 95% required laminectomy, 26% discectomy, and 49% fusion. Average time to ASD was 4 years. After a Kaplan-Meier analysis, time to reoperation for ASD was equivalent among the 1- and 2-level laminectomy cohorts (log-rank test, P = .13). CONCLUSION The cumulative incidence of ASD requiring reoperation was 10% over a mean of 4 years. Both the 1- and 2-level laminectomy cohorts experienced equivalent incidences and rates of ASD. Of the 39 operations for ASD, about half required a fusion. |
| Databáze: | OpenAIRE |
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