Early cephalad adjacent segment degeneration after posterior lumbar interbody fusion: a comparative study between cortical bone trajectory screw fixation and traditional trajectory screw fixation

Restricted access

OBJECTIVE

Cortical bone trajectory (CBT) screw insertion through a caudomedial starting point provides advantages in limiting dissection of the superior facet joints and reducing muscle dissection and the risk of superior-segment facet violation by the screw. These advantages of the cephalad CBT screw can result in lower rates of early cephalad adjacent segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF) with CBT screw fixation (CBT-PLIF) than those after PLIF using traditional trajectory screw fixation (TT-PLIF). Here, the authors investigated early cephalad ASD after CBT-PLIF and compared these results with those after TT-PLIF.

METHODS

The medical records of all patients who had undergone single-level CBT-PLIF or single-level TT-PLIF for degenerative lumbar spondylolisthesis (DLS) and with at least 3 years of postsurgical follow-up were retrospectively reviewed. At 3 years postoperatively, early cephalad radiological ASD changes (R-ASD) such as narrowing of disc height (> 3 mm), anterior or posterior slippage (> 3 mm), and posterior opening (> 5°) were examined using lateral radiographs of the lumbar spine. Early cephalad symptomatic adjacent segment disease (S-ASD) was diagnosed when clinical symptoms such as leg pain deteriorated during postoperative follow-up and the responsible lesion suprajacent to the fused segment was confirmed on MRI.

RESULTS

One hundred two patients underwent single-level CBT-PLIF for DLS and were followed up for at least 3 years (CBT group). As a control group, age- and sex-matched patients (77) underwent single-level TT-PLIF for DLS and were followed up for at least 3 years (TT group). The total incidence of early cephalad R-ASD was 12.7% in the CBT group and 41.6% in the TT group (p < 0.0001). The incidence of narrowing of disc height, anterior slippage, and posterior slippage was significantly lower in the CBT group (5.9%, 2.0%, and 4.9%) than in the TT group (16.9%, 13.0%, and 14.3%; p < 0.05). Early cephalad S-ASD developed in 1 patient (1.0%) in the CBT group and 3 patients (3.9%) in the TT group; although the incidence was lower in the CBT group than in the TT group, no significant difference was found between the two groups.

CONCLUSIONS

CBT-PLIF, as compared with TT-PLIF, significantly reduced the incidence of early cephalad R-ASD. One of the main reasons may be that cephalad CBT screws reduced the risk of proximal facet violation by the screw, which reportedly can increase biomechanical stress and lead to destabilization at the suprajacent segment to the fused segment.

ABBREVIATIONS ASD = adjacent segment degeneration; CBT = cortical bone trajectory; DLS = degenerative lumbar spondylolisthesis; JOA = Japanese Orthopaedic Association; PLIF = posterior lumbar interbody fusion; R-ASD = radiological ASD; S-ASD = symptomatic adjacent segment disease; TT = traditional trajectory.
Article Information

Contributor Notes

Correspondence Hironobu Sakaura: Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan. sakaura04061023@yahoo.co.jp.INCLUDE WHEN CITING Published online October 18, 2019; DOI: 10.3171/2019.8.SPINE19631.Disclosures Dr. Fuji is a consultant for Jansen Pharma and holds patents with United Biomech Japan, Teijin Nakashima Medical, Mizuho Ikakogyo, Century Medical, and Showa Ika Kogyo.
Headings
References
  • 1

    Babu RPark JGMehta AIShan TGrossi PMBrown CR: Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement. Neurosurgery 71:9629702012

    • Search Google Scholar
    • Export Citation
  • 2

    Cardoso MJDmitriev AEHelgeson MLehman RAKuklo TRRosner MK: Does superior-segment facet violation or laminectomy destabilize the adjacent level in lumbar transpedicular fixation? An in vitro human cadaveric assessment. Spine (Phila Pa 1976) 33:286828732008

    • Search Google Scholar
    • Export Citation
  • 3

    Cheh GBridwell KHLenke LGBuchowski JMDaubs MDKim Y: Adjacent segment disease following lumbar/thoracolumbar fusion with pedicle screw instrumentation: a minimum 5-year follow-up. Spine (Phila Pa 1976) 32:225322572007

    • Search Google Scholar
    • Export Citation
  • 4

    Chen BLWei FXUeyama KXie DHSannohe ALiu SY: Adjacent segment degeneration after single-segment PLIF: the risk factor for degeneration and its impact on clinical outcomes. Eur Spine J 20:194619502011

    • Search Google Scholar
    • Export Citation
  • 5

    He BYan LGuo HLiu TWang XHao D: The difference in superior adjacent segment pathology after lumbar posterolateral fusion by using 2 different pedicle screw insertion techniques in 9-year minimum follow-up. Spine (Phila Pa 1976) 39:109310982014

    • Search Google Scholar
    • Export Citation
  • 6

    Kim HJChun HJKang KTMoon SHKim HSPark JO: The biomechanical effect of pedicle screws’ insertion angle and position on the superior adjacent segment in 1 segment lumbar fusion. Spine (Phila Pa 1976) 37:163716442012

    • Search Google Scholar
    • Export Citation
  • 7

    Matsukawa KKato TYato YSasao HImabayashi HHosogane N: Incidence and risk factors of adjacent cranial facet joint violation following pedicle screw insertion using cortical bone trajectory technique. Spine (Phila Pa 1976) 41:E851E8562016

    • Search Google Scholar
    • Export Citation
  • 8

    Min JHJang JSJung BjLee HYChoi WCShim CS: The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion. J Spinal Disord Tech 21:3053092008

    • Search Google Scholar
    • Export Citation
  • 9

    Nakashima HKawakami NTsuji TOhara TSuzuki YSaito T: Adjacent segment disease after posterior lumbar interbody fusion: based on cases with a minimum of 10 years of follow-up. Spine (Phila Pa 1976) 40:E831E8412015

    • Search Google Scholar
    • Export Citation
  • 10

    Okuda SIwasaki MMiyauchi AAono HMorita MYamamoto T: Risk factors for adjacent segment degeneration after PLIF. Spine (Phila Pa 1976) 29:153515402004

    • Search Google Scholar
    • Export Citation
  • 11

    Okuda SMiyauchi AOda THaku TYamamoto TIwasaki M: Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. J Neurosurg Spine 4:3043092006

    • Search Google Scholar
    • Export Citation
  • 12

    Okuda SOda TYamasaki RHaku TMaeno TIwasaki M: Posterior lumbar interbody fusion with total facetectomy for low-dysplastic isthmic spondylolisthesis: effects of slip reduction on surgical outcomes: clinical article. J Neurosurg Spine 21:1711782014

    • Search Google Scholar
    • Export Citation
  • 13

    Okuda SNagamoto YMatsumoto TSugiura TTakahashi YIwasaki M: Adjacent segment disease after single segment posterior lumbar interbody fusion for degenerative spondylolisthesis. Spine (Phila Pa 1976) 43:E1384E13882018

    • Search Google Scholar
    • Export Citation
  • 14

    Park PGarton HJGala VCHoff JTMcGillicuddy JE: Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976) 29:193819442004

    • Search Google Scholar
    • Export Citation
  • 15

    Santoni BGHynes RAMcGilvray KCRodriguez-Canessa GLyons ASHenson MA: Cortical bone trajectory for lumbar pedicle screws. Spine J 9:3663732009

    • Search Google Scholar
    • Export Citation
  • 16

    Sears WRSergides IGKazemi NSmith MWhite GJOsburg B: Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis. Spine J 11:11202011

    • Search Google Scholar
    • Export Citation
  • 17

    Yang JYLee JKSong HS: The impact of adjacent segment degeneration on the clinical outcome after lumbar spinal fusion. Spine (Phila Pa 1976) 33:5035072008

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 300 300 63
Full Text Views 54 54 21
PDF Downloads 54 54 16
EPUB Downloads 0 0 0
PubMed
Google Scholar