University of Wisconsin Midwest Orthopaedics at Rush University University of Kansas University of Utah Spectrum Research, Inc. University of Washington University of California, San Francisco The Mayo Clinic Dwight D. Eisenhower Army Medical Center University of Toronto University of Saskatchewan, Royal University Hospital Thomas Jefferson University, Rothman Institute University of Virginia Washington University Indiana Spine Group University of Washington University of California, Los Angeles.
Spine (Impact Factor: 2.45). 08/2012; DOI: 10.1097/BRS.0b013e31826d62ed
Source: PubMed
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    ABSTRACT: Study Design. A retrospective comparative studyObjective. To investigate adjacent segment pathology (ASP) after limited lumbar fusion in the treatment of degenerative lumbar scoliosis (DLS).Summary of Background Data. The assessment of appropriate surgical techniques for DLS remains one of the most controversial topics in spinal surgery. So far, there has been no study specifically addressing why ASP shows different patterns with respect to different fusion levels after instrumented lumbar fusion for DLS.Methods. 59 patients were enrolled and divided into two groups with respect to the proximal fusion level: Group I consisted of 29 patients who underwent fusion below the proximal neutral vertebrae, and Group II consisted of 30 patients who underwent fusion to the proximal neutral vertebrae. Clinical and radiological assessments were performed with an average of 59.4 months of follow-up. The number of radiological findings for ASP was determined based on a 7-point scale that gave 1 point for each radiological finding. The two groups were analyzed according to radiological ASP (RASP). The ODI and VAS were recorded prospectively.Results. Overall, RASP developed in 16 (27.1%) patients. In Group I, 12 (41.4%) out of 29 patients, and in Group II, 4 (13.3%) out of 30 patients showed RASP. Group I yielded an average of 4.5 points, and in Group II, 1.8 points. RASP scores were much higher in Group I than in Group II, with statistical significance (p = 0.000). In Group I, 4 patients underwent revision surgery, but in Group II, only 1 patient did so.Conclusion. RASP displayed variance according to different fusion levels. RASP in Group I showed similar patterns to the natural progression of DLS. It is suggested that fusion be included at least at the proximal neutral vertebrae to reduce RASP although RASP with different patterns is unavoidable.
    Spine 04/2014; 39(13). DOI:10.1097/BRS.0000000000000331 · 2.45 Impact Factor
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    ABSTRACT: Park MS, Kelly MP, Lee D-H, et al. Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis. Spine J 2014;14:1228-34 (in this issue).
    The spine journal: official journal of the North American Spine Society 07/2014; 14(7):1235-6. DOI:10.1016/j.spinee.2014.05.007 · 2.80 Impact Factor
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    ABSTRACT: Study Design Retrospective cohort study. Objective To identify the incidence of adjacent segment pathology (ASP) after thoracolumbar fusion of three or more levels, the risk factors for the development of ASP, and the need for further surgical intervention in this particular patient population. Methods A retrospective analysis of a prospective surgical database identified 217 patients receiving polysegmental (≥ 3 levels) spinal fusion with minimum 5-year follow-up. Risk factors were evaluated, and the following data were obtained from the review of radiographs and charts: radiographic measures-levels fused, fusion status, presence of ASP; clinical measures-patient assessment, Oswestry Disability Index (ODI), and the need for further surgery. Results The incidence of radiographic ASP (RASP) was 29%; clinical or symptomatic ASP (CASP), 18%; and those requiring surgery, 9%. Correlation was observed between ODI and ASP, symptomatic ASP, and need for revision surgery. Age, preoperative degenerative diagnosis, and absence of fusion demonstrated significant association to ASP. Conclusions ASP was observed in a significant number of patients receiving polysegmental fusion of three or more levels. ODI scores correlated to RASP, CASP, and the need for revision surgery.
    06/2014; 4(2):83-8. DOI:10.1055/s-0034-1370693


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