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  • Title: Adequate Restoration of Disc Height and Segmental Lordosis by Lumbar Interbody Fusion Decreases Adjacent Segment Degeneration.
    Author: Tian H, Wu A, Guo M, Zhang K, Chen C, Li X, Cheng X, Zhou T, Murray SS, Sun X, Zhao J.
    Journal: World Neurosurg; 2018 Oct; 118():e856-e864. PubMed ID: 30031179.
    Abstract:
    OBJECTIVE: This study aimed to investigate the effects of lumbar interbody fusion-induced biomechanical changes on the adjacent segments, especially disc height and segmental lordosis restoration, and to provide more information for proper surgical strategy selection. METHODS: The medical records of 528 patients who underwent posterior lumbar interbody fusion were retrospectively reviewed, and a total of 89 patients were included. Surgical indications included degenerative spondylolisthesis (nonspondylolytic), marked disc herniation, or lumbar spinal stenosis requiring extensive decompression at L4/5. Postoperative adjacent segment degeneration (ASD) was assessed based on X-rays and functional status. Disc height, foraminal height, segmental lordosis, lumbar lordosis, and cage geometry were compared between the ASD and non-ASD patients. To identify the possible risk factors for radiographic ASD, univariate analysis was performed first, followed by multivariate logistic regression using variables with P < 0.20. RESULTS: Univariate analysis revealed that the postoperative disc height in the non-ASD group were significantly greater than in the ASD group. The postoperative segmental lordosis in the non-ASD group was significantly greater than that in the ASD group, and the lumbar lordosis in the non-ASD group was also significantly greater than that in the ASD group at the final follow-up visit. Four variables were identified as independent risk factors for ASD by subsequent multivariate logistic regression: postoperative relative disc height of L4/5 (P = 0.011), postoperative segmental lordosis (P = 0.046), lumbar lordosis at the final follow-up visit (P = 0.007), and cage height (P = 0.038). CONCLUSIONS: Improved lumbar lordosis is correlated with a lower incidence of ASD, and adequate disc height and segmental lordosis restoration are essential for ASD prevention.
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