Artikel
The effect of posterior ligamentous complex integrity in lumbosacral fusion on adjacent segment disease
Suche in Medline nach
Autoren
-
Periklis Godolias
- St. Josef Krankenhaus, Essen, Germany
-
Hansjörg Heep
- Universitätsmedizin Essen, St. Josef Krankenhaus Essen-Werden, Klinik für Orthopädie und Unfallchirurgie, Essen, Germany
-
Marcel Dudda
- BG Klinikum Duisburg gGmbH, Universitätsklinikum Essen, Duisburg, Germany
-
Thomas Armin Schildhauer
- BG Universitätsklinikum Bergmannsheil Bochum, Ruhr-Universität Bochum, Chirurgische Klinik und Poliklinik, Bochum, Germany
-
Jens R. Chapman
- Swedish Hospital, Seattle, United States
-
Rod Oskouian
- Seattle Science Foundation, Seattle, United States
| Veröffentlicht: | 23. Oktober 2023 |
|---|
Gliederung
Text
Objectives: The development of symptomatic adjacent segment disease (sASD) following posterior lumbar decompression and fusion (PLDF) contributes to patients’ post-operative morbidity in the form of recurrent back pain and radiculopathy and often requires further surgery. One hypothesized risk factor for sASD is the posterior ligamentous complex (PLC) integrity between the upper instrumented vertebra (UIV) and the first unfused segment (UIV+1). The purpose of this study is to determine and quantify the radiographic and clinical role of preserving the PLC between the UIV and the UIV+1 in preventing sASD.
Methods: A retrospective review of 122 patients who received a PLDF was performed. Patients were divided into groups based on the integrity of the PLC between the UIV and the UIV+1: PLC disrupted (D) and PLC intact (I). Development of ASD was assessed by standard radiographic parameters and a review of reoperation rates for sASD.
Results and conclusion: The revision rate due to sASD of the entire cohort was 7.4%. Revision rate of group-D (28 patients) exceeded the revision rate of group-I (94 patients) by 4.3% (10.7 vs. 6.4%), over a mean follow-up of three years. The mean return to the OR -time due to sASD at the UIV+1 was 2.4 years (± 1.7 y.) after index surgery. All applied radiographic indicators for ASD suggested higher incidences in patients of group-D, without statistical significance.
When the pathology allows, care should be taken to preserve the PLC during lumbar decompression and fusion surgery at the rostral aspect of the construct.
