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This article, titled “The Role of Over-level Flavectomy in Preventing Cranial Adjacent Segment Disease after Lumbar Arthrodesis,” discusses the importance of preventing adjacent segment disease (ASD) in patients undergoing L4-L5 lumbar arthrodesis. The study compares the rates of cranial ASD (CASD) in patients who underwent lumbar fusion with total laminectomy or partial laminectomy. Additionally, the study examines the role of selective over-level flavectomy (OLF) in preventing CASD. A total of 299 patients were analyzed, with 148 in the control group and 151 in the OLF group. Results showed that the OLF group had a significantly lower incidence of CASD and presented more favorable clinical outcomes. Overall, the OLF technique was found to lower the rates of CASD and improve clinical outcomes without increasing iatrogenic instability or accelerating intervertebral disc degenerative changes
Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : innovative day surgery hospital in London
Published article
CONCLUSIONS: In patients with L4-L5 degenerative spondylolisthesis and stenosis, the OLF technique may lower rates of CASD and improve clinical outcomes by preventing cranial spinal stenosis without increasing iatrogenic instability or accelerating intervertebral disc degenerative changes.
Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
Acta Neurochir (Wien). 2023 Aug 26. doi: 10.1007/s00701-023-05761-w. Online ahead of print.ABSTRACTBACKGROUND: One of the most dreaded long-term complications related to L4-L5 lumbar arthrodesis is the onset of adjacent segment disease, which most frequently occurs at the cranial level. Few studies have compared the rates of cranial adjacent segment disease (CASD) in patients undergoing lumbar,
Acta Neurochir (Wien). 2023 Aug 26. doi: 10.1007/s00701-023-05761-w. Online ahead of print.
ABSTRACT
BACKGROUND: One of the most dreaded long-term complications related to L4-L5 lumbar arthrodesis is the onset of adjacent segment disease, which most frequently occurs at the cranial level. Few studies have compared the rates of cranial adjacent segment disease (CASD) in patients undergoing lumbar fusion associated with total laminectomy at the same level with those undergoing partial laminectomy. No study has examined the role of selective over-level flavectomy (OLF; i.e., L3-L4).
METHODS: A total of 299 patients undergoing posterolateral arthrodesis (PLA) for L4-L5 degenerative spondylolisthesis were retrospectively analyzed with a 5-year follow-up. 148 patients underwent PLA + L4-L5 flavectomy + L4 partial laminectomy (control group), while 151 underwent PLA + L4-L5 flavectomy + total L4 laminectomy + L3-L4 flavectomy (OLF group). Rates of reoperations due to CASD were examined utilizing Cox proportional hazard models, while clinical improvement at follow-up (measured in ODI) was analyzed using generalized linear models (GLMs). Adjustments for potential confounders were made (grade of lumbar lordosis, age, sex, BMI, intervertebral disc degeneration, and presurgical cranial spinal stenosis).
RESULTS: At 5 years from the operation, 16 patients (10.8%) in the control group had undergone revision surgery for CASD compared to 5 patients (3.3%) in the OLF group (p = 0.013). Survival analysis and GLM demonstrated that the OLF group had a significantly lower incidence of CASD and presented more favorable clinical outcome. There were no differences in the rate of discal degeneration or the onset of Meyerding’s grade I degenerative spondylolisthesis at the adjacent segment. BMI was the only other significant predictor of ODI improvement and of the incidence of CASD.
CONCLUSIONS: In patients with L4-L5 degenerative spondylolisthesis and stenosis, the OLF technique may lower rates of CASD and improve clinical outcomes by preventing cranial spinal stenosis without increasing iatrogenic instability or accelerating intervertebral disc degenerative changes.
PMID:37632571 | DOI:10.1007/s00701-023-05761-w
The London Spine Unit : innovative day surgery hospital in London
Read the original publication:
Degenerative L4-L5 spondylolisthesis and stenosis surgery: does over-level flavectomy technique influence clinical outcomes and rates of cranial adjacent segment disease?
