Vermeidung von Anschlussdegenerationen nach operativer Therapie lumbaler, degenerativer Wirbelsäulenpathologien

Abstract

Adjacent segment degeneration (ASD) is a common complication after spine surgery and often requires surgical revision. Given its importance and the multifactorial development, numerous articles on etiology, treatment options and prevention have been published. Prior to surgery, patient-related risk factors such as BMI, age, spinal anatomy and alignment need to be part of the decision-making process. The type and extent of surgery contribute to the development of ASD as well as the damage of dorsal anatomical structures such as facet joints and the paraspinal musculature. Current literature does not justify the use of motion-preserving procedures to diminish ASD occurrence. Importantly, it is recommended to act with regard to the individual spinopelvic alignment and limit the invasiveness of the given surgical procedure in order to prevent ASD. Nevertheless, despite significant research efforts, ASD remains a complication that has not yet been adequately addressed.

Kernaussagen

• Die Entstehung einer Anschlussdegeneration ist multifaktoriell mit einer Prävalenz von 2–3% pro Jahr im Bereich der Lendenwirbelsäule.

• Anschlussdegenerationen können vor allem im Falle von klinischen Beschwerden eine Revisionsoperation erforderlich machen.

• Das Fortschreiten degenerativer Wirbelsäulenveränderungen im Anschlusssegment ist auf Basis der aktuellen Literatur als fusionsunabhängig zu verstehen.

• Zur Vermeidung von Anschlussdegenerationen sollten Operateure die Risikofaktoren berücksichtigen und Eingriffe bevorzugen, die dorsale Strukturen schonen und das spinopelvine Alignment respektieren.

• Der Einfluss des Chirurgen auf die Entstehung und Progredienz der Anschlussdegeneration ist limitiert.

• Hinsichtlich einer möglichen Risikoreduktion für das Auftreten einer Anschlussdegeneration zeigen Hybridinstrumentierungen und lumbale Bandscheibenprothesen gegenüber der Fusion keinen Vorteil.

• Eine fehlende evidenzbasierte Leitlinie zum Umgang mit Anschlussdegenerationen erschwert die Behandlung ebenso wie das Fehlen einer einheitlichen Terminologie.

Schlüsselwörter

Anschlussdegeneration - Lendenwirbelsäule - Fusion - Dekompression - Spinopelvines Alignment - Prävention

Keywords

adjacent segment degeneration - lumbar spine - fusion - decompression - spinopelvic alignment - prevention

Publikationsverlauf

Artikel online veröffentlicht:
26. August 2022

• Literatur

• 1 Xia XP, Chen HL, Cheng HB. Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976) 2013; 38: 597-608 DOI: 10.1097/BRS.0b013e318273a2ea. (PMID: 22986837)
• 2 Bydon M, Xu R, Santiago-Dieppa D. et al. Adjacent-segment disease in 511 cases of posterolateral instrumented lumbar arthrodesis: floating fusion versus distal construct including the sacrum. J Neurosurg Spine 2014; 20: 380-386 DOI: 10.3171/2013.12.Spine13789. (PMID: 24484304)
• 3 Glattes RC, Bridwell KH, Lenke LG. et al. Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine (Phila Pa 1976) 2005; 30: 1643-1649 DOI: 10.1097/01.brs.0000169451.76359.49. (PMID: 16025035)
• 4 Lee GA, Betz RR, Clements DH. et al. Proximal kyphosis after posterior spinal fusion in patients with idiopathic scoliosis. Spine (Phila Pa 1976) 1999; 24: 795-799 DOI: 10.1097/00007632-199904150-00011. (PMID: 10222531)
• 5 Lowe TG, Kasten MD. An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermann's disease. A review of 32 patients. Spine (Phila Pa 1976) 1994; 19: 1680-1685 DOI: 10.1097/00007632-199408000-00005. (PMID: 7973960)
• 6 Benoist M. Natural history of the aging spine. Eur Spine J 2003; 12 (Suppl. 02) S86-89 DOI: 10.1007/s00586-003-0593-0. (PMID: 12961079)
• 7 Jensen MC, Brant-Zawadzki MN, Obuchowski N. et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994; 331: 69-73 DOI: 10.1056/nejm199407143310201. (PMID: 8208267)
• 8 Lawrence BD, Wang J, Arnold PM. et al. Predicting the Risk of Adjacent Segment Pathology After Lumbar Fusion: A Systematic Review. Spine 2012; 37: S123-S132 DOI: 10.1097/BRS.0b013e31826d60d8. (PMID: 22885827)
• 9 Radcliff KE, Kepler CK, Jakoi A. et al. Adjacent segment disease in the lumbar spine following different treatment interventions. Spine J 2013; 13: 1339-1349 DOI: 10.1016/j.spinee.2013.03.020. (PMID: 23773433)
• 10 Panjabi MM, White AA. Basic biomechanics of the spine. Neurosurgery 1980; 7: 76-93 DOI: 10.1227/00006123-198007000-00014. (PMID: 7413053)
• 11 Lee CK, Langrana NA. Lumbosacral spinal fusion. A biomechanical study. Spine (Phila Pa 1976) 1984; 9: 574-581 DOI: 10.1097/00007632-198409000-00007. (PMID: 6495027)
• 12 Axelsson P, Johnsson R, Strömqvist B. et al. Posterolateral lumbar fusion. Outcome of 71 consecutive operations after 4 (2–7) years. Acta Orthop Scand 1994; 65: 309-314 DOI: 10.3109/17453679408995459. (PMID: 8042484)
• 13 Weinhoffer SL, Guyer RD, Herbert M. et al. Intradiscal pressure measurements above an instrumented fusion. A cadaveric study. Spine (Phila Pa 1976) 1995; 20: 526-531 DOI: 10.1097/00007632-199503010-00004. (PMID: 7604320)
• 14 Ghiselli G, Wang JC, Bhatia NN. et al. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am 2004; 86: 1497-1503 DOI: 10.2106/00004623-200407000-00020. (PMID: 15252099)
• 15 Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion?. The Spine Journal 2004; 4 (Suppl. 06) S190-S194 DOI: 10.1016/j.spinee.2004.07.007. (PMID: 15541666)
• 16 Hashimoto K, Aizawa T, Kanno H. et al. Adjacent segment degeneration after fusion spinal surgery—a systematic review. International Orthopaedics 2019; 43: 987-993 DOI: 10.1007/s00264-018-4241-z. (PMID: 30470865)
• 17 Cho KJ, Suk SI, Park SR. et al. Arthrodesis to L5 versus S1 in long instrumentation and fusion for degenerative lumbar scoliosis. Eur Spine J 2009; 18: 531-537 DOI: 10.1007/s00586-009-0883-2. (PMID: 19165507)
• 18 Yamasaki K, Hoshino M, Omori K. et al. Risk Factors of Adjacent Segment Disease After Transforaminal Inter-Body Fusion for Degenerative Lumbar Disease. Spine 2017; 42: E86-E92 DOI: 10.1097/brs.0000000000001728. (PMID: 27270640)
• 19 Wang T, Ding W. Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders: a meta-analysis. J Orthop Surg Res 2020; 15: 582 DOI: 10.1186/s13018-020-02032-7. (PMID: 33272288)
• 20 Rothenfluh DA, Mueller DA, Rothenfluh E. et al. Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion. Eur Spine J 2015; 24: 1251-1258 DOI: 10.1007/s00586-014-3454-0. (PMID: 25018033)
• 21 Bredow J, Löhrer L, Oppermann J. et al. Pathoanatomic Risk Factors for Instability and Adjacent Segment Disease in Lumbar Spine: How to Use Topping Off?. Biomed Res Int 2017; 2017: 2964529 DOI: 10.1155/2017/2964529. (PMID: 28831392)
• 22 Omair A, Mannion AF, Holden M. et al. Age and pro-inflammatory gene polymorphisms influence adjacent segment disc degeneration more than fusion does in patients treated for chronic low back pain. Eur Spine J 2016; 25: 2-13 DOI: 10.1007/s00586-015-4181-x. (PMID: 26281980)
• 23 Li XC, Huang CM, Zhong CF. et al. Minimally invasive procedure reduces adjacent segment degeneration and disease: New benefit-based global meta-analysis. PLoS One 2017; 12: e0171546 DOI: 10.1371/journal.pone.0171546. (PMID: 28207762)
• 24 Changoor S, Faloon MJ, Dunn CJ. et al. Does Percutaneous Lumbosacral Pedicle Screw Instrumentation Prevent Long-Term Adjacent Segment Disease after Lumbar Fusion?. Asian Spine J 2021; 15: 301-307 DOI: 10.31616/asj.2020.0157. (PMID: 32872750)
• 25 Mesregah MK, Yoshida B, Lashkari N. et al. Demographic, clinical, and operative risk factors associated with postoperative adjacent segment disease in patients undergoing lumbar spine fusions: a systematic review and meta-analysis. Spine J 2022; 22: 1038-1069 DOI: 10.1016/j.spinee.2021.12.002. (PMID: 34896610)
• 26 Zhou Z, Tian F-M, Wang P. et al. Alendronate Prevents Intervertebral Disc Degeneration Adjacent to a Lumbar Fusion in Ovariectomized Rats. Spine 2015; 40: E1073-E1083 DOI: 10.1097/brs.0000000000001092. (PMID: 26731708)
• 27 Luo Y, Li SY, Tian FM. et al. Effects of human parathyroid hormone 1–34 on bone loss and lumbar intervertebral disc degeneration in ovariectomized rats. International Orthopaedics 2018; 42: 1183-1190 DOI: 10.1007/s00264-018-3821-2. (PMID: 29442158)
• 28 Okuda S, Yamashita T, Matsumoto T. et al. Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: A Case Series of 1000 Patients. Global Spine J 2018; 8: 722-727 DOI: 10.1177/2192568218766488. (PMID: 30443483)
• 29 Strube P, Tohtz S, Hoff E. et al. Dynamic stabilization adjacent to single-level fusion: part I. Biomechanical effects on lumbar spinal motion. Eur Spine J 2010; 19: 2171-2180 DOI: 10.1007/s00586-010-1549-9. (PMID: 20683625)
• 30 Putzier M, Hoff E, Tohtz S. et al. Dynamic stabilization adjacent to single-level fusion: part II. No clinical benefit for asymptomatic, initially degenerated adjacent segments after 6 years follow-up. Eur Spine J 2010; 19: 2181-2189 DOI: 10.1007/s00586-010-1517-4. (PMID: 20632044)
• 31 Donnally CJ, Patel PD, Canseco JA. et al. Current incidence of adjacent segment pathology following lumbar fusion versus motion-preserving procedures: a systematic review and meta-analysis of recent projections. Spine J 2020; 20: 1554-1565 DOI: 10.1016/j.spinee.2020.05.100. (PMID: 32445805)
• 32 Epstein NE. Adjacent level disease following lumbar spine surgery: A review. Surg Neurol Int 2015; 6 (Suppl. 24) S591-599 DOI: 10.4103/2152-7806.170432. (PMID: 26693387)
• 33 Försth P, Ólafsson G, Carlsson T. et al. A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. New England Journal of Medicine 2016; 374: 1413-1423 DOI: 10.1056/NEJMoa1513721. (PMID: 27074066)
• 34 Austevoll IM, Hermansen E, Fagerland MW. et al. Decompression with or without Fusion in Degenerative Lumbar Spondylolisthesis. New England Journal of Medicine 2021; 385: 526-538 DOI: 10.1056/NEJMoa2100990. (PMID: 34347953)
• 35 Kitzen J, Vercoulen TFG, Schotanus MGM. et al. Long-Term Residual-Mobility and Adjacent Segment Disease After Total Lumbar Disc Replacement. Global Spine J 2021; 11: 1032-1039 DOI: 10.1177/2192568220935813. (PMID: 32677523)
• 36 Wang JC, Arnold PM, Hermsmeyer JT. et al. Do lumbar motion preserving devices reduce the risk of adjacent segment pathology compared with fusion surgery? A systematic review. Spine (Phila Pa 1976) 2012; 37 (Suppl. 22) S133-143 DOI: 10.1097/BRS.0b013e31826cadf2. (PMID: 22872221)
• 37 Seok SY, Cho JH, Lee HR. et al. Risk factors for worsening of sagittal imbalance after revision posterior fusion surgery in patients with adjacent segment disease. World Neurosurg 2021; DOI: 10.1016/j.wneu.2021.11.114.
• 38 Phan K, Nazareth A, Hussain AK. et al. Relationship between sagittal balance and adjacent segment disease in surgical treatment of degenerative lumbar spine disease: meta-analysis and implications for choice of fusion technique. Eur Spine J 2018; 27: 1981-1991 DOI: 10.1007/s00586-018-5629-6. (PMID: 29808425)
• 39 Barrey C, Darnis A. Current strategies for the restoration of adequate lordosis during lumbar fusion. World J Orthop 2015; 6: 117-126 DOI: 10.5312/wjo.v6.i1.117. (PMID: 25621216)
• 40 Roussouly P, Gollogly S, Berthonnaud E. et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 2005; 30: 346-353 DOI: 10.1097/01.brs.0000152379.54463.65. (PMID: 15682018)
• 41 Attiah M, Gaonkar B, Alkhalid Y. et al. Natural history of the aging spine: a cross-sectional analysis of spinopelvic parameters in the asymptomatic population. J Neurosurg Spine 2019; 32: 1-6 DOI: 10.3171/2019.7.Spine181164. (PMID: 31561232)
• 42 Ebrahimkhani M, Arjmand N, Shirazi-Adl A. Biomechanical effects of lumbar fusion surgery on adjacent segments using musculoskeletal models of the intact, degenerated and fused spine. Scientific Reports 2021; 11: 17892 DOI: 10.1038/s41598-021-97288-2. (PMID: 34504207)
• 43 Makino T, Honda H, Fujiwara H. et al. Low incidence of adjacent segment disease after posterior lumbar interbody fusion with minimum disc distraction: A preliminary report. Medicine 2018; 97: e9631 DOI: 10.1097/md.0000000000009631. (PMID: 29480873)
• 44 Liu H, Wu W, Li Y. et al. Protective effects of preserving the posterior complex on the development of adjacent-segment degeneration after lumbar fusion: clinical article. J Neurosurg Spine 2013; 19: 201-206 DOI: 10.3171/2013.5.Spine12650. (PMID: 23768024)
• 45 Imagama S, Kawakami N, Matsubara Y. et al. Radiographic Adjacent Segment Degeneration at 5 Years After L4/5 Posterior Lumbar Interbody Fusion With Pedicle Screw Instrumentation: Evaluation by Computed Tomography and Annual Screening With Magnetic Resonance Imaging. Clin Spine Surg 2016; 29: E442-e451 DOI: 10.1097/BSD.0b013e31828aec78. (PMID: 27755201)
• 46 Chang SY, Chae IS, Mok S. et al. Can Indirect Decompression Reduce Adjacent Segment Degeneration and the Associated Reoperation Rate After Lumbar Interbody Fusion? A Systemic Review and Meta-analysis. World Neurosurg 2021; 153: e435-e445 DOI: 10.1016/j.wneu.2021.06.134. (PMID: 34229099)