Dynamic Rod Constructs as the Preventive Strategy against Adjacent Segment Disease in Degenerative Lumbar Spinal Disorders: A Retrospective Comparative Cohort Study

Document Type : RESEARCH PAPER

Authors

1 Department of Neurosurgery, Razavi Hospital, Mashhad, Iran

2 Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal

3 Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

4 Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

5 Department of Neurosurgery, Golestan Hospital, Tehran, Iran

Abstract

Objectives: Adjacent segment degeneration (ASDe) and adjacent segment disease (ASDi) are potential long-term complications after lumbar fusion with rigid instrumentation. Dynamic fixation techniques (Topping-off) adjacent to the fused segments have been developed to curtail the risk of ASDe and ASDi. The current study sought to investigate whether the addition of dynamic rod constructs (DRC) in patients with preoperative degeneration in the adjacent disc was effective in reducing the risk of ASDi. Methods: A retrospective analysis was performed on clinical data of 207 patients with degenerative lumbar disorders (DLD) from January 2012 to January 2019, who underwent posterior transpedicular lumbar fusion (without Topping-off, NoT/O), and posterior dynamic instrumentation with DRC. Clinical and radiological outcomes were evaluated using Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and lumbar radiographs one, three, and 12 months postoperatively and annually. ASDe was defined as disc height collapse > 20% and disc wedging > 5. Patients with confirmed ASDe and aggravation of ODI > 20 or VAS score > 5 at final follow-up were diagnosed as ASDi. The Kaplan-Meier hazard method was used to estimate the cumulative probability of ASDi within 63 months of surgery. Results: Over three years of follow-up, 65 patients in the NoT/O (59.6%) and 52 cases (53.1%) in the DRC groups met the diagnostic criteria for ASDe. Furthermore, 27 (24.8%) patients in the NoT/O group showed ASDi during the follow-up, compared to 14 (14.3%) cases in the DRC group (P=0.059). Revision surgery was performed on 19 individuals in the NoT/O and 8 cases in the DRC groups (P=0.048). The Cox regression model identified a significantly decreased risk of ASDi if DRC was used (Hazard ratio: 0.29; 95% CI: 0.13-0.6). Conclusion: Dynamic fixation adjacent to the fused segment is an effective strategy for preventing ASDi in carefully selected individuals with preoperative degenerative changes at the adjacent level. Level of evidence: II

Keywords

Main Subjects

References

1. Sears WR, Solterbeck AC, Kos JA. Risk of adjacent segment
disease after ‘topping-off’ multi-level lumbar fusions with
posterior dynamic stabilisers: an observational cohort study.
Eur Spine J.2021; 30(1):181-190. doi: 10.1007/s00586-020-
06628-9.
2. Lingutla K, Pollock R, Benomran E, et al. Outcome of lumbar
spinal fusion surgery in obese patients: a systematic review
and meta-analysis. Bone Joint J.2015; 97-B (10):1395-404.
doi: 10.1302/0301-620X.97B10.35724.
3. Chou P-H, Lin H-H, An HS, Liu K-Y, Su W-R, Lin C-L. Could the
Topping-Off Technique Be the Preventive Strategy against
Adjacent Segment Disease after Pedicle Screw-Based Fusion
in Lumbar Degenerative Diseases? A Systematic Review.
Biomed Res Int. 2017; 2017:4385620. doi:
10.1155/2017/4385620.
4. Cheh G, Bridwell KH, Lenke LG, et al. Adjacent segment
disease followinglumbar/thoracolumbar fusion with pedicle
screw instrumentation: a minimum 5-year follow-up. Spine
(Phila Pa 1976).2007; 32(20):2253-7. doi:
10.1097/BRS.0b013e31814b2d8e.
5. Dobran M, Nasi D, Esposito DP, Gladi M, Scerrati M, Iacoangeli
M. The Incidence of Adjacent Segment Degeneration after the
Use of a Versatile Dynamic Hybrid Stabilization Device in
Lumbar Stenosis: Results of a 5–8-Year Follow-up. Asian
Spine J. 4 2018; 12(2):263-271.
doi:10.4184/asj.2018.12.2.263.
6. Fuster S, Martínez-Anda JJ, Castillo-Rivera SA, VargasReverón C, Tornero E. Dynamic Fixation Techniques for the
Prevention of Adjacent Segment Disease: A Retrospective
Controlled Study. Asian Spine J. 2022; 16(3):401-410.
doi:10.31616/asj.2020.0585.
7. Wang T, Ding W. Risk factors for adjacent segment
degeneration after posterior lumbar fusion surgery in
treatment for degenerative lumbar disorders: a metaanalysis. J Orthop Surg Res.2020; 15(1):582. doi:
10.1186/s13018-020-02032-7.
8. Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE. Adjacent
segment disease after lumbar or lumbosacral fusion: review
of the literature. Spine. 2004; 29(17):1938-1944. doi:
10.1097/01.brs.0000137069.88904.03.
9. Chen B-L, Wei F-X, Ueyama K, Xie D-H, Sannohe A, Liu S-Y.
Adjacent segment degeneration after single-segment PLIF:
the risk factor for degeneration and its impact on clinical
outcomes. Eur Spine J.2011; 20(11):1946-50. doi:
10.1007/s00586-011-1888-1.
10. Okuda S, Oda T, Miyauchi A, et al. Lamina horizontalization
and facet tropism as the risk factors for adjacent segment
degeneration after PLIF. Spine .2008; 33(25):2754-2758. doi:
10.1097/BRS.0b013e31817bb9c2.
11. Khoueir P, Kim KA, Wang MY. Classification of posterior
dynamic stabilization devices. Neurosurg Focus.2007;
22(1):E3. doi: 10.3171/foc.2007.22.1.3.
12. Baioni A, Di Silvestre M, Greggi T, Vommaro F, Lolli F, Scarale
A. Does hybrid fixation prevent junctional disease after
posterior fusion for degenerative lumbar disorders? A
minimum 5-year follow-up study. Eur Spine J.2015; 24 Suppl
7:855-64. doi: 10.1007/s00586-015-4269-3.
13. Maserati MB, Tormenti MJ, Panczykowski DM, Bonfield CM,
Gerszten PC. The use of a hybrid dynamic stabilization and
fusion system in the lumbar spine: preliminary experience.
Neurosurg Focus.2010; 28(6):E2. doi:
10.3171/2010.3.FOCUS1055.
14. Putzier M, Hoff E, Tohtz S, Gross C, Perka C, Strube P. Dynamic
stabilization adjacent to single-level fusion: part II. No clinical
benefit for asymptomatic, initially degenerated adjacent
segments after 6 years follow-up. Eur Spine J.2010;
19(12):2181-9. doi: 10.1007/s00586-010-1517-4.
15. Lee C-H, Jahng T-A, Hyun S-J, et al. Dynamic stabilization
using the Dynesys system versus posterior lumbar interbody
fusion for the treatment of degenerative lumbar spinal
disease: a clinical and radiological outcomes-based metaanalysis. Neurosurg Focus.2016; 40(1):E7. doi:
10.3171/2015.10.FOCUS15426.
16. Wang H, Chow SC. Sample size calculation for comparing
proportions. Wiley Encyclopedia of Clinical Trials. 2007 Dec
14; 10:9781118445112.
17. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N.
Magnetic resonance classification of lumbar intervertebral
disc degeneration. Spine (Phila Pa 1976).2001; 26(17):1873-
8. doi: 10.1097/00007632-200109010-00011.
18. Liang J, Dong Y, Zhao H. Risk factors for predicting
symptomatic adjacent segment degeneration requiring
surgery in patients after posterior lumbar fusion. J Orthop
Surg Res. 2014; 9:97. doi:10.1186/s13018-014-0097-0
19. Kim DY, Lee SH, Lee HY, et al. Validation of the Korean version
of the oswestry disability index. Spine (Phila Pa 1976) 2005; 30(5):E123 doi:10.1097/01.brs.0000157172.00635.3a
20. Chapman JR, Norvell DC, Hermsmeyer JT, et al. Evaluating
common outcomes for measuring treatment success for
chronic low back pain. Spine (Phila Pa 1976) .2011; 36(21
Suppl):S54-68. doi:10.1097/BRS.0b013e31822ef74d
21. Froud R, Patel S, Rajendran D, et al. A Systematic Review of
Outcome Measures Use, Analytical Approaches, Reporting
Methods, and Publication Volume by Year in Low Back Pain
Trials Published between 1980 and 2012: Respice, adspice, et
prospice. PLoS One 2016; 11(10):e0164573.
doi:10.1371/journal.pone.0164573
22. Alentado VJ, Lubelski D, Healy AT, et al. Predisposing
characteristics of adjacent segment disease after lumbar
fusion. Spine (Phila Pa 1976).2016; 41(14):1167-1172. doi:
10.1097/BRS.0000000000001493.
23. Bydon M, Xu R, Santiago-Dieppa D, et al. Adjacent-segment
disease in 511 cases of posterolateral instrumented lumbar
arthrodesis: floating fusion versus distal construct including
the sacrum. J Neurosurg Spine.2014; 20(4):380-6. doi:
10.3171/2013.12.SPINE13789.
24. Norvell DC, Dettori JR, Skelly AC, Riew KD, Chapman JR,
Anderson PA. Methodology for the systematic reviews on an
adjacent segment pathology. Spine (Phila Pa 1976).2012;
37(22 Suppl):S10-7. doi: 10.1097/BRS.0b013e31826cd9c8
25. Kaito T, Hosono N, Mukai Y, Makino T, Fuji T, Yonenobu K.
Induction of early degeneration of the adjacent segment after
posterior lumbar interbody fusion by excessive distraction of
lumbar disc space. J Neurosurg Spine.2010; 12(6):671-9. doi:
10.3171/2009.12.SPINE08823.
26. Helgeson MD, Bevevino AJ, Hilibrand AS. Update on the
evidence for adjacent segment degeneration and disease.
Spine J.2013; 13(3):342-51. doi:
10.1016/j.spinee.2012.12.009.
27. Spallone A. A less-invasive technique for harvesting
autologous iliac crest grafts for cervical interbody fusion. Surg
Neurol.2007; 67(2):160-2; discussion 162. doi:
10.1016/j.surneu.2006.07.012.
28. Sasso R, Garrido B. Journal of spinal disorders & techniques. J
Spinal Disord Tech 2007; 20(2):118-122. doi:
10.1097/01.bsd.0000211263.13250.b1.
29. Zhu Z, Liu C, Wang K, et al. Topping-off technique prevents
aggravation of degeneration of adjacent segment fusion
revealed by retrospective and finite element biomechanical
analysis. J Orthop Surg Res.2015; 10:10. doi:
10.1186/s13018-014-0142-z.
30. Kashkoush A, Agarwal N, Paschel E, Goldschmidt E, Gerszten
PC. Evaluation of a hybrid dynamic stabilization and fusion
system in the lumbar spine: a 10 year experience.
Cureus.2016; 8(6):e637. doi: 10.7759/cureus.637.
31. Beastall J, Karadimas E, Siddiqui M, et al. The Dynesys lumbar
spinal stabilization system: a preliminary report on positional
magnetic resonance imaging findings. Spine (Phila Pa
1976).2007; 32(6):685-90. doi:
10.1097/01.brs.0000257578.44134.fb.
32. Cabello J, Cavanilles-Walker J, Iborra M, Ubierna M, Covaro A,
Roca J. The protective role of dynamic stabilization on the
adjacent disc to a rigid instrumented level. An in vitro
biomechanical analysis. Arch Orthop Trauma Surg.2013;
133(4):443-8. doi: 10.1007/s00402-013-1685-x.
33. Herren C, Sobottke R, Pishnamaz M, et al. The use of the
DTO™ hybrid dynamic device: a clinical outcome-and
radiological-based prospective clinical trial. BMC
Musculoskelet Disord. 2018; 19(1):199. doi:
10.1186/s12891-018-2103-x.
34. Chen X-L, Guan L, Liu Y-Z, Yang J-C, Wang W-L, Hai Y.
Interspinous dynamic stabilization adjacent to fusion versus
double-segment fusion for treatment of lumbar degenerative
disease with a minimum follow-up of three years. Int
Orthop.2016; 40(6):1275-83. doi: 10.1007/s00264-016-
3199-y.
35. Pan A, Hai Y, Yang J, Zhou L, Chen X, Guo H. Adjacent segment
degeneration after lumbar spinal fusion compared with
motion-preservation procedures: a meta-analysis. Eur Spine
J.2016; 25(5):1522-1532. doi: 10.1007/s00586-016-4415-6.
36. Wang W, Sun X, Zhang T, Sun S, Kong C, Lu S. Topping-off
technology versus posterior lumbar interbody fusion in the
treatment of lumbar disc herniation: a meta-analysis. Biomed
Res Int.2020; 2020:2953128. doi: 10.1155/2020/2953128.
37. Roitberg B, Zileli M, Sharif S, Anania C, Fornari M, Costa F.
Mobility-Preserving Surgery for Lumbar Spinal Stenosis:
WFNS Spine Committee Recommendations. World Neurosurg
X.2020; 7:100078. doi: 10.1016/j.wnsx.2020.100078. 
The Archives of Bone and Joint Surgery
Volume 11, Issue 6
June 2023
Pages 404-413

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History

  • Receive Date: 19 October 2022
  • Revise Date: 25 November 2022
  • Accept Date: 17 December 2022

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