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Revista Española de Cirugía Ortopédica y Traumatología (English Edition)
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Inicio Revista Española de Cirugía Ortopédica y Traumatología (English Edition) Incidence and risk factors of adjacent disc degeneration after lumbar fusion
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Vol. 55. Issue 3.
Pages 170-174 (May - June 2011)
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Vol. 55. Issue 3.
Pages 170-174 (May - June 2011)
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Incidence and risk factors of adjacent disc degeneration after lumbar fusion
Incidencia y factores de riesgo de degeneración de los discos límites a una fusión lumbar
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A. Marsol-Puig
Corresponding author
amarsolp@hotmail.com

Corresponding author.
, R. Huguet-Comelles, J. Escala-Arnau, J. Giné-Gomà
Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitari Joan XXIII, Tarragona, Spain
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Abstract
Objective

The aim of this retrospective study is to determine the incidence, the rate of adjacent disc degeneration (ADD) and to analyse the major risk factors after instrumented lumbar fusion.

Materials and methods

Retrospective consecutive study of 230 patients, with lumbar degenerative disease, who underwent lumbar or lumbosacral instrumented spine fusion between 1990 and 2000. We used radiographic criteria (X-RAY and MRI) in order to determine ADD, and we analysed the following risk factors: age, gender, number of levels fused, adjacent disc status before surgery, segmental lordosis and lumbosacral lordosis, and finally, the facet joint angle of adjacent disc.

Results

ADD was found in 41 (17.82%) patients, the mean follow-up period was 8.5 years. The average age was 59 years with female predominance. L5-S1 fusion showed a significant (P<.05) lower risk for developing degenerative changes at the adjacent segments than any other fusions. The cranial level of the fused segment was mainly affected in 36 (87.8%) patients and 19 (46%) patients required surgery. The average interval from surgery to the development of ADD was 6.1 years.

Conclusions

There is a risk of 17.82% (41 patients) of being affected by radiographic ADD in an average of 6 years after the first surgery, with a risk of 6.26% (19 patients) of having surgery. The gender, number of levels fused and fusion to the sacrum were the main risk factors.

Keywords:
Lumbar arthrodesis
Adjacent disc injury
Risk factors
Incidence
Resumen
Objetivo

Determinar la incidencia y analizar los posibles factores de riesgo de desarrollar una degeneración del disco adyacente después de una artrodesis lumbar instrumentada.

Material y método

Estudio retrospectivo consecutivo de 230 pacientes con patología degenerativa lumbar, tratados entre los años 1990 y 2000 mediante una artrodesis instrumentada posteroexterna lumbar o lumbosacra. Se ha valorado la afectación del disco adyacente, mediante un criterio radiológico con RX y RM, y se han analizado los siguientes factores de riesgo: la edad, el sexo, el número de niveles instrumentados, el estado del disco límite previo a la cirugía, la lordosis del segmento instrumentado y la lordosis lumbosacra, y la sagitalización de las facetas articulares del disco límite.

Resultados

Hemos observado 41 pacientes (17,82%) afectos de síndrome del disco adyacente, con un seguimiento medio de 8,5 años. La edad media fue de 59 años con predominio del sexo femenino. La fusión L5-S1 presenta menos incidencia de afectación del disco límite (p<0,05). Se afectó mayoritariamente el disco adyacente proximal en 36 pacientes (87,8%) y 19 pacientes (46%) requirió cirugía. El tiempo medio hasta el diagnóstico del disco adyacente radiológico ha sido de 6,1 años.

Conclusiones

Existe un riesgo del 17,82% (41 pacientes) de presentar disco adyacente radiológico a los 6 años después de la primera cirugía con un riesgo de 6,26% (19 pacientes) de ser intervenido. El sexo, el número de niveles fusionados y la fusión hasta el sacro han sido los principales factores de riesgo.

Palabras clave:
Artrodesis lumbar
Lesión disco adyacente
Factores de riesgo
Incidencia
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Copyright © 2011. Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT). All rights reserved
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