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Frequency, risk factors, and treatment of distal adjacent segment pathology after long thoracolumbar fusion: a systematic review.

Publication ,  Journal Article
Kasliwal, MK; Shaffrey, CI; Lenke, LG; Dettori, JR; Ely, CG; Smith, JS
Published in: Spine (Phila Pa 1976)
October 15, 2012

STUDY DESIGN: Systematic review. OBJECTIVE: To systematically review the literature related to distal adjacent segment pathology (ASP) after long thoracolumbar fusions for deformity including frequency, risk factors, frequency differences between adolescents and adults, surgical approach for revision, and revision complications. SUMMARY OF BACKGROUND DATA: Spinal deformity surgery complications include ASP. Although ASP at the rostral end of instrumented fusions has been well described, substantially less has been documented about distal ASP. METHODS: A systematic search was conducted in Medline and the Cochrane Collaboration Library for articles published between January 1, 1983, and March 15, 2012. We included all articles that described distal ASP after long thoracolumbar fusion for deformity. Radiographical ASP (RASP) was defined as evidence of ASP based on imaging, and clinical ASP (CASP) was defined as symptomatic ASP. RESULTS: Seven retrospective cohort studies met inclusion criteria. Distal CASP developed in 17.7% at 2- 6-year follow-up and 19.8% at 9-year follow-up, whereas reoperation due to CASP was reported in 15.6% at 2 to 6 years and 14.4% at 9 years. Distal RASP was more frequent (44.7%-65.5%). Preoperative sagittal imbalance was associated with increased risk of distal ASP. There was increased risk of CASP in patients with higher postoperative fractional curve and increased risk of RASP in younger patients and those with preoperative disc degeneration, longer fusions, circumferential procedures, and postoperative L5-S1 disc space narrowing. No studies meeting inclusion criteria compared distal ASP in adults and adolescents or defined the best approach or complications for distal ASP revision. CONCLUSION: Low-quality evidence suggests a cumulative rate of 18% to 20% for CASP and 45% to 65% for RASP after long thoracolumbar fusion for spinal deformity during 9-year follow-up. Low-quality evidence suggests an association between preoperative sagittal imbalance and distal ASP, with greater risk of distal ASP in patients with sagittal imbalance. Low-quality evidence suggests increased risk of CASP in patients with higher postoperative fractional curve and increased risk of RASP in younger patients and those with preoperative disc degeneration, longer fusions, circumferential procedures, and postoperative L5-S1 disc space narrowing. CONSENSUS STATEMENT: 1. The risk of developing new symptoms secondary to distal adjacent segment pathology following long thoracolumbar fusion for deformity is approximately 18–20% during a period of 9 years follow up, and most of these patients will require revision surgery. Strength of Statement: Weak. 2. The risk of developing distal adjacent segment pathology may be higher in those with preoperative sagittal imbalance, preoperative disc degeneration, longer fusions, circumferential procedures, and postoperative L5–S1 disc space narrowing. Strength of Statement: Weak.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

October 15, 2012

Volume

37

Issue

22 Suppl

Start / End Page

S165 / S179

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Fusion
  • Risk Factors
  • Orthopedics
  • Lumbar Vertebrae
  • Intervertebral Disc Degeneration
  • Intervertebral Disc
  • Humans
  • 4201 Allied health and rehabilitation science
  • 3209 Neurosciences
 

Citation

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Kasliwal, M. K., Shaffrey, C. I., Lenke, L. G., Dettori, J. R., Ely, C. G., & Smith, J. S. (2012). Frequency, risk factors, and treatment of distal adjacent segment pathology after long thoracolumbar fusion: a systematic review. Spine (Phila Pa 1976), 37(22 Suppl), S165–S179. https://doi.org/10.1097/BRS.0b013e31826d62c9
Kasliwal, Manish K., Christopher I. Shaffrey, Lawrence G. Lenke, Joseph R. Dettori, Claire G. Ely, and Justin S. Smith. “Frequency, risk factors, and treatment of distal adjacent segment pathology after long thoracolumbar fusion: a systematic review.Spine (Phila Pa 1976) 37, no. 22 Suppl (October 15, 2012): S165–79. https://doi.org/10.1097/BRS.0b013e31826d62c9.
Kasliwal MK, Shaffrey CI, Lenke LG, Dettori JR, Ely CG, Smith JS. Frequency, risk factors, and treatment of distal adjacent segment pathology after long thoracolumbar fusion: a systematic review. Spine (Phila Pa 1976). 2012 Oct 15;37(22 Suppl):S165–79.
Kasliwal, Manish K., et al. “Frequency, risk factors, and treatment of distal adjacent segment pathology after long thoracolumbar fusion: a systematic review.Spine (Phila Pa 1976), vol. 37, no. 22 Suppl, Oct. 2012, pp. S165–79. Pubmed, doi:10.1097/BRS.0b013e31826d62c9.
Kasliwal MK, Shaffrey CI, Lenke LG, Dettori JR, Ely CG, Smith JS. Frequency, risk factors, and treatment of distal adjacent segment pathology after long thoracolumbar fusion: a systematic review. Spine (Phila Pa 1976). 2012 Oct 15;37(22 Suppl):S165–S179.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

October 15, 2012

Volume

37

Issue

22 Suppl

Start / End Page

S165 / S179

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Fusion
  • Risk Factors
  • Orthopedics
  • Lumbar Vertebrae
  • Intervertebral Disc Degeneration
  • Intervertebral Disc
  • Humans
  • 4201 Allied health and rehabilitation science
  • 3209 Neurosciences