Adjacent segment disease after minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar diseases: incidence and risk factors

Abstract

Study design: Retrospective study.

Objectives: To explore the incidence and risk factors for symptomatic adjacent segment disease (ASD) in patients enveloped in degenerative lumbar diseases after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

Methods: Data were retrospectively analyzed on 744 patients who underwent MIS-TLIF for degenerative lumbar diseases in our hospital from October 2012 to December 2018. The patients were divided into the ASD group and non-ASD (N-ASD) group on the basis of developing ASD at follow-up, and then the incidence of ASD was calculated. Clinical and radiological risk factors were assessed over time to determine their association with ASD by excluding less important factors.

Results: Data were missing for 26 patients, while a total of 718 patients were successfully monitored after MIS-TLIF. Of the 718 individuals participated in the study, 34 (4.7%) patients plagued by ASD required surgical intervention. The average onset time of ASD was 62.7 ± 15.1 months. Univariate analysis results shows that age, bone mineral density (BMD), body mass index (BMI), preoperative adjacent intervertebral disc height and preoperative adjacent segment disc degeneration were significantly different between the ASD and N-ASD groups (p < 0.05). The logistic regression analysis results demonstrated that BMD (p = 0.039, OR = 0.986, 95% CI 0.899-1.115), BMI (p = 0.041, OR = 1.119, 95% CI 1.103-2.397), and preoperative adjacent intervertebral disc degeneration (p = 0.023, OR = 1.215, 95% CI 1.015-1.986) may be seen as risk factors for ASD after MIS-TLIF.

Conclusions: The incidence of ASD was about 4.7% in patients suffer from degenerative lumbar diseases after MIS-TLIF. BMD, BMI and preoperative adjacent intervertebral disc degeneration might be the risk factors for the occurrence of ASD after MIS-TLIF. Our research also suggested that patients with lower BMD, higher BMI and disc preoperative adjacent segment disc degeneration were more likely to develop ASD after MIS-TLIF.

Keywords: Adjacent segment disease; Degenerative lumbar diseases; Minimally invasive transforaminal lumbar interbody fusion; Risk factors.

Fig. 1

The specific inclusion and exclusion process and grouping

Fig. 2

The incidence of ASD was not significantly different among the DS/IS, LI, LSS. DS: degenerative spondylolisthesis, IS: isthmic spondylolisthesis, LI: lumbar instability, LSS: lumbar spinal stenosis

Fig. 3

A 54-year-old male, with L4/5 lumbar disc herniation (A and B), MIS-TLIF was performed on L4/5 in November 2012 (C and D). In August 2021, the patient developed numbness and pain in the left leg. MRI showed that the L5/S1 disc was herniated and compress the left nerve root (E and F). His diagnosis of ASD and MIS-TLIF was performed by MRI at L5/S1 (G and H)