J Korean Orthop Assoc.  2010 Aug;45(4):314-320.

The Revision Operation Rate for Adjacent Segmental Degeneration by Survival Analysis in Mono-segment Lumbar Fusion

• Kim TH
• Kim JH
• Kim SS
• Lim DJ
• Han JI
• Kim TW
• Suk SI

Abstract

PURPOSE
To analyze survival rates of patients after mono-segmental lumbar or lumbosacral fusion and to evaluate factors affecting the revision operation due to adjacent segmental degeneration. MATERIALS AND
METHODS
This study enrolled 1,206 patients who had mono-segmental lumbar or lumbosacral fusion between March 1997 and December 2006 at the Seoul Spine Institute. The survival rates for the revision operation due to adjacent segmental degeneration were analyzed retrospectively. The age at index operation, sex, etiologic diagnosis, fusion method, fusion level, substance of bone graft, operator, body mass index (BMI), and smoking were considered as risk factors for the revision operation.
RESULTS
There were 27 patients with a revision operation for adjacent segmental degeneration (2.24%). The average follow-up period was 39.0 months (6 months to 12 years 6 months) and the average age at operation was 47.0 years (13 to 85 years). The survival rate at 5 years was 97.3%, and at 10 years it was 89.4%. Patients less than 50 years old had a significantly lower revision operation rate than those aged 50 or more (p=0.002). When fusion between the 4th lumbar and the 5th lumbar spinal vertebrae was done, the revision operation rate was significantly higher than for other levels (p=0.003). Obese patients with BMI> or =25 had a significantly higher revision rate than did patients with BMI<25 (p=0.040). In a comparison of circumferential fusion versus other types of fusion, circumferential fusion had a lower revision rate and the difference was significant (p=0.021). Other factors such as diagnosis, sex, surgeon, substance used for the bone graft, and smoking were not significant for revision rate (ps>0.05). In multivariate analysis, age alone was a significant risk factor (p=0.048, Hazard ratio=2.50).
CONCLUSION
The most important factor for survival without revision surgery for adjacent segmental degeneration following instrumented mono-segment lumbar or lumbosacral fusion is the age at index operation. Patients 50 year-old or older should be informed of the possibility of adjacent segmental disease after instrumented mono-segment lumbar or lumbosacral fusion.

Keyword

adjacent segmental degeneration; mono-segment fusion; survival rate; revision operation; lumbar spine

MeSH Terms

Aged
Body Mass Index
Follow-Up Studies
Humans
Multivariate Analysis
Retrospective Studies
Risk Factors
Smoke
Smoking
Spine
Survival Analysis*
Survival Rate
Transplants
Smoke

Figure

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  Figure 1 The survival rate was 97.3% at 5 years, 91.6% at 7 years, and 89.4% at 10 years.

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  Figure 2 Univariate Analysis. (A) Age at operation, (B) Fusion level, (C) Fusion method, and (D) Obesity.

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