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The lumbar adjacent-level syndrome: analysis of clinical, radiological, and surgical parameters in a large single-center series – Lumbar Fusion

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This article discusses a study that aimed to identify the demographic, clinical, radiological, and surgical risk factors associated with the development of adjacent-level syndrome in patients undergoing lumbar fusion procedures. The study analyzed a large surgical series and found that risk factors for adjacent-level syndrome included age older than 65 years, high body mass index (BMI), preexisting disc degeneration at the adjacent level, and high postoperative pelvic tilt. Patients older than 65 years were found to achieve higher levels of clinical improvement and postsurgical satisfaction compared to younger patients. The study emphasizes the importance of identifying these risk factors to implement prevention strategies in patients undergoing lumbar arthrodesis surgery

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : top treatment hospital in London

Published article

CONCLUSIONS: Identifying risk factors for the development of adjacent-level syndrome allows the implementation of a prevention strategy in patients undergoing lumbar arthrodesis surgery. Age older than 65 years, high BMI, preexisting disc degeneration at the adjacent level, and high postoperative pelvic tilt are the most relevant factors. In addition, patients older than 65 years achieve higher levels of clinical improvement and postsurgical satisfaction than do younger patients.

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J Neurosurg Spine. 2023 Jul 14:1-11. doi: 10.3171/2023.5.SPINE235. Online ahead of print.ABSTRACTOBJECTIVE: The development of specific clinical and neurological symptoms and radiological degeneration affecting the segment adjacent to a spinal arthrodesis comprise the framework of adjacent-level syndrome. Through the analysis of a large surgical series, this study aimed to identify possible demographic, clinical, radiological, and,

J Neurosurg Spine. 2023 Jul 14:1-11. doi: 10.3171/2023.5.SPINE235. Online ahead of print.

ABSTRACT

OBJECTIVE: The development of specific clinical and neurological symptoms and radiological degeneration affecting the segment adjacent to a spinal arthrodesis comprise the framework of adjacent-level syndrome. Through the analysis of a large surgical series, this study aimed to identify possible demographic, clinical, radiological, and surgical risk factors involved in the development of adjacent-level syndrome.

METHODS: A single-center retrospective analysis of adult patients undergoing lumbar fusion procedures between January 2014 and December 2018 was performed. Clinical, demographic, radiological, and surgical data were collected. Patients who underwent surgery for adjacent-segment disease (ASD) were classified as the ASD group. All patients were evaluated 1 month after the surgical procedure clinically and radiologically (with lumbar radiographs) and 3 months afterward with CT scans. The last follow-up was performed by telephone interview. The median follow-up for patients included in the analysis was 67.2 months (range 39-98 months).

RESULTS: A total of 902 patients were included in this study. Forty-nine (5.4%) patients required reoperation for ASD. A significantly higher BMI value was observed in the ASD group (p < 0.001). Microdiscectomy and microdecompression procedures performed at the upper or lower level of an arthrodesis without fusion extension have a statistically significant impact on the development of ASD (p = 0.001). Postoperative pelvic tilt in the ASD group was higher than in the non-ASD group. Numeric rating scale, Core Outcome Measures Index, and Oswestry Disability Index scores at the last follow-up were significantly higher in patients in the ASD group and in patients younger than 65 years.

CONCLUSIONS: Identifying risk factors for the development of adjacent-level syndrome allows the implementation of a prevention strategy in patients undergoing lumbar arthrodesis surgery. Age older than 65 years, high BMI, preexisting disc degeneration at the adjacent level, and high postoperative pelvic tilt are the most relevant factors. In addition, patients older than 65 years achieve higher levels of clinical improvement and postsurgical satisfaction than do younger patients.

PMID:37486878 | DOI:10.3171/2023.5.SPINE235

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The lumbar adjacent-level syndrome: analysis of clinical, radiological, and surgical parameters in a large single-center series

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J Neurosurg Spine. 2023 Jul 14:1-11. doi: 10.3171/2023.5.SPINE235. Online ahead of print.ABSTRACTOBJECTIVE: The development of specific clinical and neurological symptoms and radiological degeneration affecting the segment adjacent to a spinal arthrodesis comprise the framework of adjacent-level syndrome. Through the analysis of a large surgical series, this study aimed to identify possible demographic, clinical, radiological, and

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