Clin Orthop Surg.  2010 Sep;2(3):140-147. 10.4055/cios.2010.2.3.140.

Survival and Prognostic Analysis of Adjacent Segments after Spinal Fusion

• Ahn DK
• Park HS
• Choi DJ
• Kim KS
• Yang SJ

• KMID: 999432
• DOI: http://doi.org/10.4055/cios.2010.2.3.140

Abstract

BACKGROUND
To examine the survival function and prognostic factors of the adjacent segments based on a second operation after thoracolumbar spinal fusion.
METHODS
This retrospective study reviewed 3,188 patients (3,193 cases) who underwent a thoracolumbar spinal fusion at the author's hospital. Survival analysis was performed on the event of a second operation due to adjacent segment degeneration. The prognostic factors, such as the cause of the disease, surgical procedure, age, gender and number of fusion segments, were examined. Sagittal alignment and the location of the adjacent segment were measured in the second operation cases, and their association with the types of degeneration was investigated.
RESULTS
One hundred seven patients, 112 cases (3.5%), underwent a second operation due to adjacent segment degeneration. The survival function was 97% and 94% at 5 and 10 years after surgery, respectively, showing a 0.6% linear reduction per year. The significant prognostic factors were old age, degenerative disease, multiple-level fusion and male. Among the second operation cases, the locations of the adjacent segments were the thoracolumbar junctional area and lumbosacral area in 11.6% and 88.4% of cases, respectively. Sagittal alignment was negative or neutral, positive and strongly positive in 47.3%, 38.9%, and 15.7%, respectively. Regarding the type of degeneration, spondylolisthesis or kyphosis, retrolisthesis, and neutral balance in the sagittal view was noted in 13.4%, 36.6%, and 50% of cases, respectively. There was a significant difference according to the location of the adjacent segment (p = 0.000) and sagittal alignment (p = 0.041).
CONCLUSIONS
The survival function of the adjacent segments was 94% at 10 years, which had decreased linearly by 0.6% per a year. The likelihood of a second operation was high in those with old age, degenerative disease, multiple-level fusion and male. There was a tendency for the type of degeneration to be spondylolisthesis or kyphosis in cases of the thoracolumbar junctional area and strongly positive sagittal alignment, but retrolisthesis in cases of the lumbosacral area and neutral or positive sagittal alignment.

Keyword

Survival analysis; Prognosis; Spinal fusion; Adjacent segment

MeSH Terms

Female
Humans
Lumbar Vertebrae/pathology/*surgery
Male
Middle Aged
Prognosis
Reoperation
Spinal Diseases/pathology/surgery
*Spinal Fusion
Survival Analysis
Thoracic Vertebrae/pathology/*surgery

Figure

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  Fig. 1 This graph shows the number of cases according to the surgical site.

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  Fig. 2 (A) Comparison of the surgical segment between spondylolisthesis or kyphosis group and retrolisthesis group. (B) Comparison of the sagittal balance between the spondylolisthesis or kyphosis group and retrolisthesis group.

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  Fig. 3 This graph shows the survival function after thoracolumbar spinal fusion that reduced linearly. Overall survival function was approximately 97% at 60 months and approximately 94% at the 120 month follow-up.

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  Fig. 4 Different survival function of the adjacent segment according to age. The 120 month survival function was 98% for < 61 year-old age group and 88% for equal or above the 61 year-old age group (p = 0.000).

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  Fig. 5 Different survival function of the adjacent segment according to disease. The 120 month survival function was 92% for the degenerative disease group and 97% for the other group (p = 0.000).

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  Fig. 6 Different survival function of the adjacent segment according to gender. The 120 month survival function was 95% for women and 92% for men (p = 0.087).

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  Fig. 7 Different survival function of the adjacent segment according to number of fusion segment. The 120 month survival function was 95% for the single-level fusion group and 91% for the above multiple-level fusion group (p = 0.012).

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  Fig. 8 Survival function of the adjacent segment in cases with all 4 negative prognostic factors. The 120 month survival function was 61%.

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