Adjacent Segment Disease After Interbody Fusion and Pedicle Screw Fixations for Isolated L4–L5 Spondylolisthesis
| Autor: | Chan Shik Shim, Woei-Jack Pan, Dong Yeob Lee, Kyeong Hwan Kim, Hyeonseon Park, Ho-Yeon Lee, Sang-Ho Lee |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Spinal stenosis Asymptomatic Central nervous system disease Pedicle Screws mental disorders medicine Back pain Humans Orthopedics and Sports Medicine Aged Retrospective Studies Lumbar Vertebrae medicine.diagnostic_test business.industry Magnetic resonance imaging Middle Aged medicine.disease Magnetic Resonance Imaging Spondylolisthesis Surgery Radiography Stenosis Logistic Models Spinal Fusion Treatment Outcome Female Neurology (clinical) medicine.symptom Claudication business Follow-Up Studies |
| Zdroj: | Spine. 35:625-634 |
| ISSN: | 0362-2436 |
| Popis: | Study design A retrospective study. Objective The purpose of this study are (1) to analyze prevalence of clinical and radiologic adjacent segment diseases (ASD), (2) to find precipitating factor of clinical ASD in each isthmic and degenerative spondylolisthesis groups, and (3) to compare clinical and radiologic change in isthmic and degenerative spondylolisthesis. Summary of background data There is no clinical report regarding the use of magnetic resonance imaging (MRI) for evaluating ASD in patient who underwent 360° fusion with single-level spondylolisthesis with healthy adjacent segment. Methods A total of 69 patients who underwent instrumented single-level interbody fusion at the L4-L5 level and showed no definitive degenerated disc in adjacent segments on preoperative MRI and plain radiographs were evaluated at more than 5 years after surgery. The patients were divided into 2 groups: group I was isthmic spondylolisthesis patients and group II was degenerative spondylolisthesis patients. The radiologic ASD was diagnosed by plain radiographs and MRI. Clinical ASD is defined as symptomatic spinal stenosis, intractable back pain, and subsequent sagittal or coronal imbalance with accompanying radiographic changes. Symptomatic spinal stenosis was defined as stenosis diagnosed by MRI and combined with neurologic claudication. Results The prevalence of radiologic ASD on group I and group II was 72.7% and 84.0%, respectively. About 7 (15.9%) patients showed clinical ASD in group I and 6 (24.0%) patients showed clinical ASD in group II. MRI showed significant reliability for diagnosis of clinical ASD. Compared with patients with asymptomatic ASD, patients with clinical ASD showed significantly less postoperative lordotic angle at the L4-L5 level (i.e., less than 20°) in both groups. Conclusion Maintaining postoperative L4-L5 segmental lordotic angle at about 20° or more is important for prevention of clinical ASD in single-level 360° fusion operation. MRI is reliable method for diagnosing clinical ASD. |
| Databáze: | OpenAIRE |
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