Indication for Spinal Fusion and the Risk of Adjacent Segment Pathology: Does Reason for Fusion Affect Risk? A Systematic Review
ABSTRACT STUDY DESIGN.: A systematic review. OBJECTIVE.: To determine whether different indications or reasons for spinal fusion are associated with different risks of subsequent adjacent segment pathology (ASP) in the lumbar and cervical spine. SUMMARY OF BACKGROUND DATA.: Pre-existing degeneration at levels adjacent to an arthrodesis may play a role in the development of symptomatic adjacent segment pathology. Although most spinal arthrodeses occur in patients with degenerative spinal disease, spinal fusion occurs in the pediatric and trauma population, and also congenitally. Evaluating the risk of ASP in these populations may shed light on its etiology. METHODS.: A systematic search was conducted in PubMed and the Cochrane Library for articles published between January 1, 1990, and December 31, 2011. We included all articles that described the risk of radiographical adjacent segment pathology (RASP) following surgical fusion for degenerative disease, for trauma, or for conditions requiring fusion in pediatrics in the lumbar or cervical spine. In addition, we included studies recording ASP in patients with congenital fusion. RESULTS.: Nineteen studies met our inclusion criteria. In patients who underwent fusion in the lumbar spine for degenerative reasons, the RASP rate averaged 12.4% during an average of 5.6-year follow-up. For patients who underwent fusion in the cervical spine for degenerative reasons, the average RASP rate was 25.3% during a 2.3-year follow-up. For patients with Klippel-Feil syndrome and congenital fusion, the RASP rate averaged 49.7% during an average of 23.5-years of follow-up. In patients who were fused for scoliosis, the average RASP rate was 20.3% of 3.9-year follow-up. However there is significant variation between studies in patient population, follow-up, and definition of RASP. CONCLUSION.: In the cervical spine, the rate of RASP in patients with fusion for degenerative reasons indications is greater than the rate of RASP in patients with congenital fusion suggesting that the pre-existing health and status of the adjacent level at the time of fusion may play a contributory role in the development of ASP. There is insufficient evidence in the literature to determine whether the indication/reason for fusion affects the risk of RASP in the lumbar spine CONSENSUS STATEMENT: In the cervical spine, the rate of RASP in patients with fusion for degenerative reasons indications is greater than the rate of RASP in patients with congenital fusion suggesting that the pre-existing health and status of the adjacent level at the time of fusion may play a contributory role in the development of ASP.Strength of Statement: Weak.
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ABSTRACT: To compare the clinical efficacy and radiological outcome of treating 4-level cervical spondylotic myelopathy (CSM) with either anterior cervical discectomy and fusion (ACDF) or "skip" corpectomy and fusion, 48 patients with 4-level CSM who had undergone ACDF or SCF at our hospital were analyzed retrospectively between January 2008 and June 2011. Twenty-seven patients received ACDF (Group A) and 21 patients received SCF. Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and Cobb's angles of the fused segments and C2-7 segments were compared in the two groups. The minimum patient follow-up was 2 years. No significant differences between the groups were found in demographic and baseline disease characteristics, duration of surgery, or follow-up time. Our study demonstrates that there was no significant difference in the clinical efficacy of ACDF and SCF, but ACDF involves less intraoperative blood loss, better cervical spine alignment, and fewer postoperative complications than SCF.BioMed Research International 01/2015; 2015:513906. DOI:10.1155/2015/513906 · 2.71 Impact Factor
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ABSTRACT: A series of studies have been conducted to evaluate the effectiveness of unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion, but there is still controversy about which one is more superior. We performed a meta-analysis to more accurately estimate the effectiveness of unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Studies on the comparison between unilateral and bilateral pedicle screw fixation in lumbar spinal fusion were identified from PubMed, SpringerLink, China National Knowledge Infrastructure (CNKI), the Wanfang database and the China Biology Medical literature database (CBM) and related references were searched. The included trials were screened according to the criteria of inclusion and exclusion. The quality of included trials was evaluated. Data were extracted by two reviewers independently. RevMan 5.1.1 was used for data analysis. The fixed or random effect model was selected based on the heterogeneity test among studies evaluated using the I2 statistic. A total of nine studies involving 567 patients were included in the analyses for the effectiveness of unilateral versus bilateral pedicle screw fixation in lumbar spinal fusion. Unilateral pedicle screw fixation was performed in 287 patients and bilateral pedicle screw fixation in 280 patients. The results of the meta-analysis indicated that statistically significant differences were observed between the two fixation procedures with regard to mean operation time and amount of bleeding. There were no differences in hospitalisation days, fusion rate, complication rate, and excellent and good rates. This meta-analysis suggested that both unilateral and bilateral pedicle screw fixation are effective in one or two segmental lumbar spinal fusion. In comparison with bilateral fixation, unilateral fixation can shorten the operation time, reduce the amount of bleeding, and reduce medical expenses. There were similar effects with regard to hospitalisation days, fusion rate, complication rate, and excellent and good rates.04/2014; 2(2):66–74. DOI:10.1016/j.jot.2014.03.001
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ABSTRACT: Background: Reported surgical treatment for injuries and instabilities of the paediatric cervical spine most commonly involves posterior fusion with internal fixation, usually posterior wiring. Purpose: To present a new simple technique of stabilization without fusion of the upper cervical spine of young children. Study design: A technical report. Methods: Detailed description of the surgical procedure carried out for stabilizing an unstable flexion-distraction injury in a 23 month-old toddler, with severe head injury and pneumothorax is presented. Results: A rare unstable flexion-distraction injury in the upper cervical spine of a toddler was successfully treated with a posterior Number 2 Vicryl (polyglactin 910) suture fixation, with good healing of the ligaments and endplates, without fusion. Preservation of motion was achieved without obvious instability at 63 months post-surgery. Conclusions: In selected cases of cervical spine injuries in the young paediatric population, a limited approach to the injured spinal segments and simple stabilization using suitable degradable sutures, can provide sufficient stability until healing occurs. Advantages: fusion is avoided, growth disturbances are prevented and spinal motion maintained.Injury 05/2014; 45(11). DOI:10.1016/j.injury.2014.05.027 · 2.46 Impact Factor