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. 2022 Jun 1;35(5):E444-E450.
doi: 10.1097/BSD.0000000000001292. Epub 2021 Dec 29.

The Effect of L5-S1 Degenerative Disc Disease on Outcomes of L4-L5 Fusion

William Conaway  1 , Brian A Karamian, Jennifer Z Mao, Parth Kothari, Jose A Canseco, Daniel R Bowles, Stephen L DiMaria, Nicholas C Semenza, Alec J Massood, Teleale F Gebeyehu, Nadim Kheir, Winston W Yen, Barrett I Woods, Joseph K Lee, Jeffrey A Rihn, I David Kaye, Christopher K Kepler, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder
Affiliations

The Effect of L5-S1 Degenerative Disc Disease on Outcomes of L4-L5 Fusion

William Conaway et al. Clin Spine Surg. .

Abstract

Study design: Retrospective cohort study.

Objective: The aim was to investigate the clinical relevance of preoperative caudal adjacent segment degeneration (ASD) in patients undergoing isolated L4-5 fusion to determine a threshold of degeneration at which a primary L4-S1 fusion would be warranted.

Summary of background data: Increased motion and biomechanical forces across the adjacent caudal segment in isolated L4-L5 fusion leads to concerns regarding the increased incidence of revision surgery because of the development of ASD.

Methods: Patients who underwent isolated L4-L5 fusion between 2014 and 2019 were reviewed. Pfirrmann grading and the disc heights of the caudal level relative to the rostral level were used to quantify preoperative adjacent degenerative disc disease. To assess the influence of preoperative caudal degenerative disc disease, preoperative disc height ratios (DHRs) were compared for patients who reported minimal, moderate, and severe Oswestry disability index (ODI) sores on postoperative assessment. For each patient-reported outcome measure (PROM), adjacent DDD was compared for those who did and did not meet MCID. An area under curve analysis was used to identify a threshold of degeneration impacting outcomes from the preoperative DHR.

Results: A total of 123 patients were studied with an average follow-up of 2.11 years. All patients demonstrated a significant improvement in all PROMs after surgery. When categorizing patients based on the severity of postoperative ODI scores, there were no preoperative differences in the L5-S1 Pfirrmann grading or DHRs. There was a significant association between greater preoperative anterior DHR and an increased number patients who met MCID for visual analog scale back. There were no radiographic differences in preoperative L5-S1 Pfirrmann grade or DHR for ODI, visual analog scale leg, MCS-12, or PCS-12. area under curve analysis was not able to identify a preoperative DHR threshold that reflected worse MCID for any PROM.

Conclusion: No preoperative radiographic indicators of caudal ASD were predictive of worse clinical outcomes after isolated L4-5 fusion.

Level of evidence: Level III.

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Conflict of interest statement

Dr Schroeder has received funds to travel from AO Spine and Medtronic. Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. In addition, Dr Vaccaro has also provided expert testimony. He has also served as deputy editor/editor of Clinical Spine Surgery. The remaining authors declare no conflict of interest.

References

    1. Epstein NE. Older literature review of increased risk of adjacent segment degeneration with instrumented lumbar fusions. Surg Neurol Int. 2016;7:S70–S76.
    1. Virk SS, Niedermeier S, Yu E, et al. Adjacent segment disease. Orthopedics. 2014;37:547–555.
    1. Dekutoski MB, Schendel MJ, Ogilvie JW, et al. Comparison of in vivo and in vitro adjacent segment motion after lumbar fusion. Spine. 1994;19:1745–1751.
    1. Ekman P, Möller H, Shalabi A, et al. A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration. Eur Spine J. 2009;18:1175–1186.
    1. Weinhoffer SL, Guyer RD, Herbert M, et al. Intradiscal pressure measurements above an instrumented fusion: a cadaveric study. Spine. 1995;20:526–531.

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