J Korean Neurosurg Soc.  2019 Sep;62(5):603-609. 10.3340/jkns.2019.0144.

Is Adjacent Segment Disease More Frequent in Proximal Levels in Comparison with Distal Levels? Based on Radiological Data of at Least 2 Years Follow Up with More than 2 Level Thoracolumbar Fusions

• Kim JH
• Ryu DS
• Yoon SH

• KMID: 2457951
• DOI: http://doi.org/10.3340/jkns.2019.0144

Abstract

OBJECTIVE
The purpose of this retrospective study was to determine which of the proximal adjacent segment disease (ASD) and distal ASD was more prevalent and what parameters is more related to ASD in proximal levels and distal levels after more than 2 levels fusions.
METHODS
The medical records were reviewed retrospectively for 856 cases. A total of 66 cases of ASD were enrolled. On pre-op magnetic resonance imaging, disc degeneration was measured at the upper and lower parts of surgically treated levels and confirmed by the commonly used Pfirrmann grade. Segmental flexibility in sagittal plane was embodied in segment range of motion (ROM) obtained through flexion and extension X-ray before surgery. Coronal angle was recorded as methods Cobb's angle including fusion levels preoperatively. For the comparison of categorical variables between two independent groups, the chi-square test and Fisher exact test were performed.
RESULTS
Proximal ASD and distal ASD were 37/856 (4.32%) and 29/856 (3.39%), respectively. The incidence of proximal ASD was relatively high but insignificant differences. In comparison between ASD group and non ASD group, proximal Pfirmman was higher in proximal ASD and distal Pfirmman was higher in distal ASD group (p=0.005, p<0.008, respectively). However, in the ROM, proximal ROM was higher in proximal ASD, but distal ROM was not different between the two groups (p<0.0001, p=0.995, respectively). Coronal angle was not quite different in both groups (p=0.846).
CONCLUSION
In spite of higher frequency in ASD in proximal level in spinal fusion, it is not clear that incidence of ASD in proximal level is not higher than that of distal ASD group in more than 2 level thoracolumbar fusions. Not only Pfirrmann grade but also proximal segmental ROM is risk factor for predicting the occurrence of ASD in patients more than 2 level of thoracolumbar spine fusion operation excluding L5S1.

Keyword

Pfirrmann; Intervertebral disc degeneration; Range of motion, Articular; Segment flexibility; Adjacent segment disease; Radiographical ASD

MeSH Terms

Follow-Up Studies*
Humans
Incidence
Intervertebral Disc Degeneration
Magnetic Resonance Imaging
Medical Records
Pliability
Range of Motion, Articular
Retrospective Studies
Risk Factors
Spinal Fusion
Spine

Figure

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  Fig. 1. Pre (A and B) and postoperative (C and D) flexion-extension views of the lumbar spine. The upper and lower endplate Cobb's angles were used. The difference (c-a) and difference (d-b) were set as preoperative proximal ROM and preoperative distal ROM, respectively. Likewise, postoperative proximal ROM is the difference (g-e) and postoperative distal ROM is difference (h-f). ROM : range of motion.

Reference

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