J Korean Orthop Assoc.  2008 Apr;43(2):160-165. 10.4055/jkoa.2008.43.2.160.

Clinical Results and Changes of Adjacent Segment after Whole Lumbosacral Fusion

• Cho JL
• Park YS
• Yoon JP

• KMID: 2106434
• DOI: http://doi.org/10.4055/jkoa.2008.43.2.160

Abstract

PURPOSE: To analyze the clinical and radiological results of whole lumbosacral fusion, and to identify whether an extension of the fusion level is required.
MATERIALS AND METHODS
A retrospective review was carried out on 40 patients who had undergone whole lumbosacral fusion. The adjacent segment changes were evaluated by the radiological findings including intervertebral space narrowing, traction spur, endplate sclerosis and vacuum phenomenon. The clinical results were evaluated using a visual analogue scale (VAS) and Oswestry disability index (ODI).
RESULTS
The mean age was 63.8 years and the mean follow-up period was 41.7 months. At the last follow-up, adjacent segment changes were observed in 12 cases of intervertebral space narrowing, 15 cases of traction spur, 20 cases of endplate sclerosis and 8 cases of vacuum phenomenon. In the clinical results, the VAS was improved to 4.0 points from 7.6 points, and the ODI improved to 43.9% from 86.0%. There were no revision cases due to adjacent segment problems.
CONCLUSION
Whole lumbosacral fusion in spinal stenosis with degenerative lumbar scoliosis was concomitant with some adjacent segment problems, but presented favorable outcomes. For the prevention of junctional problem, caution should be taken when extending the fusion level to the proximal level in whole lumbosacral fusion.

Keyword

Whole lumbosacral fusion; Adjacent segment

MeSH Terms

Follow-Up Studies
Humans
Retrospective Studies
Sclerosis
Scoliosis
Spinal Stenosis
Traction
Vacuum

Figure

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  Fig. 1 69-year-old female patient. (A) Preoperative X-ray showed degenerative changes with mild scoliosis. (B) At postoperative 42 months, the X-ray showed no additional adjacent segmental changes compared with the preoperative state and bony union was well done.

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  Fig. 2 53-year-old female patient. (A) Preoperative X-ray showed degenerative lumbar disease with scoliosis. (B) At postoperative 39 months, the X-ray was showed intervertebral space narrowing, a traction spur, end plate sclerosis and vacuum phenomenon of the adjacent segment. However, the patient was satisfied with the result of the operation and did not complain of low back pain or radiating pain.

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