Treatment for the Sequential Degenerative Changes at the Adjacent Segments to Lumbar Fusion

Kim, Hong Tae; Jang, Byung Doo; Hyun, Kyoung Hoon; Nam, Jun Mo

Abstract

STUDY DESIGN: A retrospective clinical and radiographic review.
OBJECTIVES
To assess the treatment for the recurred symptoms caused by various sequential degenerative changes at the adja-cent segments to previous lumbar fusion. SUMMARY OF LITERATURE REVIEW: Accelerated degeneration of lumbar segments adjacent to a previous fusion has been established, but the treatment for this condition has rarely been demonstrated.
MATERIALS AND METHODS
19 consecutive patients who had treatments for the recurred symptoms caused by a sequential degenerative change at the adjacent segments were reviewed. The sequential changes at the adjacent segments were instability, disc space narrowing, spinal stenosis, and/or vertebral slip, and the symptoms of these changes were back pain in all patients and leg pain in many patients, particularly in later years.
RESULTS
Initially all symptomatic patients were tried with conservative regimens of medication, physiotherapy, exercise, and education. A back brace was also applied for the patients who have considerable back pain, and the epidural injections for those who have leg pain. The symptoms of these patients, particularly the back pain were responded well to the conservative therapy during the earlier years, but surgery was needed eventually at the later years in 8 patients, particularly for the leg pain. For these patients, an adequate decompression and extension of the fusion using instrumentation resulted in good fusion with satisfactory clinical outcomes.
CONCLUSION
The initial symptoms of the sequential degenerative changes at the adjacent segment after lumbar fusion were well responded to the conservative treatments, but a surgical treatment was needed eventually in many patients. The methods and results of the surgical treatment were similar to those of primary conditions.