• Eur Spine J · Aug 2013

    Additional decompression at adjacent segments leads to adjacent segment degeneration after PLIF.

    • Masayuki Miyagi, Osamu Ikeda, Seiji Ohtori, Yoshikazu Tsuneizumi, Yukio Someya, Masataka Shibayama, Yasufumi Ogawa, Gen Inoue, Sumihisa Orita, Yawara Eguchi, Hiroto Kamoda, Gen Arai, Tetsuhiro Ishikawa, Yasuchika Aoki, Tomoaki Toyone, Toshio Ooi, and Kazuhisa Takahashi.
    • Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. masayuki008@aol.com
    • Eur Spine J. 2013 Aug 1;22(8):1877-83.

    PurposeAdjacent segment degeneration (ASD) is one of the major complications of lumbar fusion. Several previous retrospective studies reported ASD after PLIF. However, few reports evaluated whether decompression surgery combined with fusion surgery increases the rate of complications in adjacent segments. The purpose of the current study was to investigate the degeneration in decompressed adjacent segments after PLIF.MethodsA total of 23 patients (12 men, 11 women; average age, 58.6) who underwent PLIF surgery [1 level (n = 9), 2 levels (n = 8), 3 levels (n = 4), 4 levels (n = 2)] were included. Additional adjacent decompression above or below the level of interbody fusion was performed at 25 levels and no adjacent decompression was performed at 15 levels. We retrospectively investigated ASD by X-ray films of all 40 adjacent segments (above and below fusion level) and clinical outcomes of all 23 cases.ResultsOf the 40 adjacent segments, 19 (47.5%) showed ASD and 9 (22.5%) showed symptomatic ASD. In the 19 segments with ASD, ASD occurred in 16 of 25 (64.0%) segments at decompressed sites compared with 3 of 15 (20.0%) non-decompressed sites. The ratio of ASD in adjacent segments was significantly higher at decompressed sites than at non-decompressed sites (p < 0.01).ConclusionASD occurs frequently in association with additional decompression above or below the level of PLIF. In cases in which the adjacent segments require decompression, a surgical strategy that preserves as much of the posterior complex as possible should be selected.

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