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  • Symptomatic Adjacent Segment Degeneration after Minimally Invasive Transforaminal Lumbar Interbody Fusion. Long Term Follow up

    Final Number:
    1691

    Authors:
    Mick J. Perez-Cruet MD MS; Esam A Elkhatib MD, PhD; Elizabeth Abel BS

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Adjacent segment degeneration is a long term complication after posterior lumbar spine arthrodesis. The use of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) may result in decreasing the percentage of symptomatic adjacent segment disease (ASD) due to preservation of the posterior column supporting anatomy.

    Methods: A retrospective chart review was performed to determine the rates of degeneration at the adjacent segment related to the site of a posterior lumbar fusion. The selection criteria includ-ed the cases that required surgical interference due to debilitating back pain or leg pain. Four hun-dred and three patients who had undergone posterior lumbar arthrodesis from 2011 to 2017 were included in this study, of which 242(60%) were females and 161(40%) were males. Age ranged from 43 to 77 years old, average 67.5 years. Follow up ranged from 1 to 6 years. The radiological analysis was done pre-operative and at last follow up time. Radiological diagnosis based on the positive Modic changes in the disc space with debilitating low back pain and/or leg pain of the re-lated nerve root.

    Results: Nine (2.2%) cases of the 403 patients had evidence of symptomatic degeneration at the adjacent levels that required an additional surgery. All nine cases were females (100%). 97.8% of cases has no symptomatic adjacent level disease at 6 years follow up time. 66.7% of cases had adjacent level stenosis, 88.9% had spondylolisthesis of which 62% had previous double level arthrodesis. 33% had BMI more than 30kg/m2 . 77.8% of the ASD cases had previous double level lumbar surgery of which L4-5 + L5-S1 levels constituted 66.7% and only 2 cases (22.2%) had degenerative scoli-osis.

    Conclusions: TLIF surgery has a low adjacent segment disease percentage probably due to the preservation of the posterior column anatomy that leads to maintenance of good spine stabilization.

    Patient Care: Adjacent segment degeneration is a long term complication after posterior lumbar spine arthrodesis. The use of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) may result in decreasing the percentage of symptomatic adjacent segment disease (ASD) due to preservation of the posterior column supporting anatomy.

    Learning Objectives: TLIF surgery has a low adjacent segment disease percentage probably due to the preservation of the posterior column anatomy

    References:

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