Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumba
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(2020) 15:582
SYSTEMATIC REVIEW
Open Access
Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders: a meta-analysis Tao Wang1 and Wenyuan Ding2*
Abstract Study design: A meta-analysis. Objective: We performed a meta-analysis to explore the incidence and risk factors of adjacent segment degeneration (ASD) after posterior lumbar fusion surgery. Methods: An extensive search of the literature was performed in English database of PubMed, Embase, and Cochrane Library, and Chinese database of CNKI and WANFANG (up to May 2020). We collected factors including demographic data, surgical factor, and sagittal parameters. Data analysis was conducted with RevMan 5.3 and STATA 12.0. Results: Finally, 19 studies were included in the final analysis. In our study, the rate of ASD after posterior lumbar fusion surgery was 18.6% (540 of 2896). Our data also showed that mean age, body mass index (BMI), the history of smoking and hypertension, preoperative adjacent disc degeneration, long-segment fusion, preoperative superior facet violation, high lumbosacral joint angle, pre- and post-operative L1-S1 sagittal vertical axis (SVA), post-operative lumbar lordosis (LL), and preoperative pelvic incidence (PI) were associated with the development of ASD. However, gender, history of diabetes, bone mineral density (BMD), preoperative Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA), the type of fusion (PLIF vs TLIF), type of bone graft (auto- vs allograft), fusion to S1(vs non-fusion to S1), diagnose (lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis), preoperative pelvic tilt (PT), LL and sacral slope (SS), post-operative SS, PT and PI were not associated with the development of ASD. Conclusions: In our study, many factors were correlated with the risk of ASD after posterior lumbar fusion surgery. We hope this article can provide a reference for spinal surgeons in treatment for lumbar degenerative diseases. Keywords: Incidence, Risk factors, Adjacent segment degeneration, Lumbar, Fusion surgery, Posterior, Meta-analysis
Introduction Due to good clinical results, posterior lumbar fusion surgeries have been widely used in treatment for various lumbar degenerative diseases. Though the initially good clinical results after fusion, biomechanical change of the * Correspondence: [email protected] 2 Department of Spinal Surgery, The Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang 050051, China Full list of author information is available at the end of the article
spine caused by fusion may accelerate the degeneration of the adjacent segment [1]. So, adjacent segment disease or adjacent segment degeneration (ASD) is considered to be a potential long-term complication of spinal fusion. The rate of ASD, considered radiographic changes without symptom, ranges from 5.2 to 49% in various studies after posterior lumbar fusion surgery [2]. Some researchers found that ASD may be caused by lumbar f
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