J Korean Neurosurg Soc.  2015 Feb;57(2):108-113. 10.3340/jkns.2015.57.2.108.

Survival Rates and Risk Factors for Cephalad and L5-S1 Adjacent Segment Degeneration after L5 Floating Lumbar Fusion : A Minimum 2-Year Follow-Up

• Lee YS
• Kim YB
• Park SW

• KMID: 2191191
• DOI: http://doi.org/10.3340/jkns.2015.57.2.108

Abstract

OBJECTIVE
Although the L5-S1 has distinct structural features in comparison with other lumbar spine segments, not much is known about adjacent segment degeneration (ASD) at the L5-S1 segment. The aim of study was to compare the incidence and character of ASD of the cephalad and L5-S1 segments after L5 floating lumbar fusion.
METHODS
From 2005 to 2010, 115 patients who underwent L5 floating lumber fusion were investigated. The mean follow-up period was 46.1 months. The incidence of radiological and clinical ASD of the cephalad and the L5-S1 segments was compared using survival analysis. Risk factors affecting ASD were analyzed using a log rank test and the Cox proportional hazard model.
RESULTS
Radiological ASD of the L5-S1 segment had a statistically significant higher survival rate than that of the cephalad segment (p=0.001). However, clinical ASD of the L5-S1 segment was significantly lower survival rates than that of the cephalad segment (p=0.038). Risk factor analysis showed that disc degeneration of the cephalad segment and preoperative spinal stenosis of the L5-S1 segment were risk factors.
CONCLUSION
In L5 floating fusion, radiological ASD was more common in the cephalad segment and clinical ASD was more common in the L5-S1 segment. At the L5-S1 segment, the degree of spinal stenosis appears to be the most influential risk factor in ASD incidences, unlike the cephalad segment.

Keyword

Radiological adjacent segment degeneration; Clinical adjacent segment degeneration; Cephalad segment; L5-S1 segment

MeSH Terms

Follow-Up Studies*
Humans
Incidence
Intervertebral Disc Degeneration
Proportional Hazards Models
Risk Factors*
Spinal Stenosis
Spine
Survival Rate*

Figure

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  Fig. 1 Kaplan-Meier survivorship curve. The survival rate of the cephalad and caudad (L5-S1) segments for radiological adjacent segment degeneration (ASD) (p=0.001).

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  Fig. 2 Kaplan-Meier survivorship curve. The survival rate of the cephalad and caudad (L5-S1) segments for clinical adjacent segment degeneration (ASD) (p=0.038).

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  Fig. 3 Kaplan-Meier survivorship curve. The survival rate of the cephalad and caudad (L5-S1) segments for reoperation (p=0.288).

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