Nearby Segment Disease in the Lumber Spine
Hesham Hamed Refae
Orthopedics Surgery Department, South valley University hospital Qena, Egypt
Abstract: Background: Between January 2006 and December 2010, Nintey two patients with posterior lumbar fusion(PLF) had the potential for nearby segment (NSD) disease cephalic or caudal to the fusion segment. There is controversy regarding the subsequent degeneration of adjacent segments, and we are aware of no long-term studies that have analyzed both cephalic and caudal degeneration after (PLF). Patients and Methods: The mean age of the patients was 55 (45-65) years, 60 females and 32 males. The average duration of follow-up was 36 to 48 Months. A retrospective investigation was performed to determine the rates of degeneration and survival of the motion segments adjacent to the site of (PLF) .Radiographs were analyzed with regard to arthritic degeneration at the adjacent levels both preoperatively and at the time of the last follow-up visit. Disc spaces were graded on a 4-point arthritic degeneration scale and assessed symptoms from the adjacent segment. Results:. 18 patients of 92 patients included in this study is found to have (NSD) at the cephalic adjacent segment after 3 to 4 years of the (PLF),10 of them met radiologic criteria for (NSD) which defined by; Development of spondylolisthesis >4 mm, Segmental kyphosis >10°, Complete collapse of disc space, or more than 2 grades worsening of Weiner classification and the remeaning 8 patient had symptomatic (NSD) which defined as; symptomatic spinal stenosis, Intractable back pain, or Subsequent sagittal or coronal imbalance ,2 of them had been treated only by decompression and the other 6 with decompression and extension of ( PLF) up to the affected segmentConclusion: Symptomatic degeneration at an adjacent segment with (PLF) was after about 36 to 48 months from time of operation, no correlation with the preoperative arthritic degeneration of the adjacent segment but patients whose facet joint at the adjacent segment had a more sagittal orientation had postoperative anterior listhesis, which caused symptomatic (NSD).
[Hesham Hamed Refae. Nearby Segment Disease in the Lumber Spine. J Am Sci 2013;9(6):143-148]. (ISSN: 1545-1003). http://www.jofamericanscience.org. 16
Keyword: Adjacent segment disease, postreolateral interbody fusion, lumber spine. Full Text 16