Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty

STUDY DESIGN: Systematic review of published incidence of radiographic adjacent segment degeneration (ASDeg) and symptomatic adjacent segment disease (ASDis) after arthrodesis or total disc replacement. OBJECTIVE: Assess impact of surgery method and other factors on the incidence of ASDeg and ASDis. SUMMARY OF BACKGROUND DATA: Twenty-seven articles, none of which were class I or II, met the inclusion criteria. Twenty involved arthrodesis (1732 patients) and 7 involved arthroplasty (758 patients). Nineteen detailed ASDeg and 16 detailed ASDis. METHODS: Data were established for number of patients, gender, average patient age, incidence of ASDeg and ASDis, average time to follow-up, and level and type of surgery. Multivariate logistic regression was used to identify which parameters had a significant effect on the incidence of ASDeg and ASDis. RESULTS: Three hundred fourteen of 926 patients in the arthrodesis group (34%) and 31 out of 313 patients in the total disc replacement group (9%) developed ASDeg. (P < 0.0001) Multivariate logistic regression indicated that higher odds of ASDeg were associated with: older patients (P < 0.001); arthodesis (P = 0.0008); and longer follow-up (P = 0.0025). For ASDis, 173/1216 (14%) arthrodesis patients developed ASDis compared to 7/595 (1%) of arthroplasty patients (P < 0.0001). Using multivariate logistic regression, higher odds of ASDis were seen in studies with fusion (P < 0.0001), higher percentages of male patients (P = 0.0019), and shorter follow-up (P < 0.05). CONCLUSION: Analysis of the literature suggests a correlation between fusion and the development of ASDeg compared to arthroplasty, but this association is dampened by the influence of patient age. There is a stronger correlation between fusion and ASDis compared to arthroplasty. The data supports only a class C recommendation (lowest tier) for the use of arthroplasty to reduce ASDis and disc degeneration compared to arthrodesis Keywords : Arthroplasty,Arthroplasty,Replacement,Chi-Square Distribution,Diskectomy,epidemiology,Humans,Incidence,Intervertebral Disc,Logistic Models,Lumbar Vertebrae,Male,methods,pathology,Postoperative Complications,Prosthesis Implantation,Spinal Fusion,surgery,, Adjacent,Segment,Degeneration,Disease, orthopedic clinic london ontario

Date of Publication : 2008 Jul 1

Authors : Harrop JS;Youssef JA;Maltenfort M;Vorwald P;Jabbour P;Bono CM;Goldfarb N;Vaccaro AR;Hilibrand AS;

Organisation : Department of Orthopaedics and Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA. James.harrop@jefferson.edu

Journal of Publication : Spine (Phila Pa 1976 )

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/18594464

The London Spine Unit : Harley Street UK. Specialists in Cutting Edge Technologies for Spinal Surgery

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