Asian Spine Journal

Korean Society of Spine Surgery (대한척추외과학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of the Degenerative Changes of the Distal Intervertebral Discs after Internal Fixation Surgery in Adolescent Idiopathic Scoliosis

  • Dehnokhalaji, Morteza (Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences) ;
  • Golbakhsh, Mohammad Reza (Department of Orthopedic Surgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences) ;
  • Siavashi, Babak (Department of Orthopedic Surgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences) ;
  • Talebian, Parham (Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences) ;
  • Javidmehr, Sina (Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences) ;
  • Bozorgmanesh, Mohammadreza (Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences)
  • Received : 2017.06.03
  • Accepted : 2018.04.17
  • Published : 2018.12.31
⟨ Previous Next ⟩

Abstract

Study Design: Retrospective study. Purpose: Lumbar intervertebral disc degeneration is an important cause of low back pain. Overview of Literature: Spinal fusion is often reported to have a good course for adolescent idiopathic scoliosis (AIS). However, many studies have reported that adjacent segment degeneration is accelerated after lumbar spinal fusion. Radiography is a simple method used to evaluate the orientation of the vertebral column. magnetic resonance imaging (MRI) is the method most often used to specifically evaluate intervertebral disc degeneration. The Pfirrmann classification is a well-known method used to evaluate degenerative lumbar disease. After spinal fusion, an increase in stress, excess mobility, increased intra-disc pressure, and posterior displacement of the axis of motion have been observed in the adjacent segments. Methods: we retrospectively secured and analyzed the data of 15 patients (four boys and 11 girls) with AIS who underwent a spinal fusion surgery. We studied the full-length view of the spine (anterior-posterior and lateral) from the X-ray and MRI obtained from all patients before surgery. Postoperatively, another full-length spine X-ray and lumbosacral MRI were obtained from all participants. Then, pelvic tilt, sacral slope, curve correction, and fused and free segments before and after surgery were calculated based on X-ray studies. MRI images were used to estimate the degree to which intervertebral discs were degenerated using Pfirrmann grading system. Pfirrmann grade before and after surgery were compared with Wilcoxon signed rank test. While analyzing the contribution of potential risk factors for the post-spinal fusion Pfirrmann grade of disc degeneration, we used generalized linear models with robust standard error estimates to account for intraclass correlation that may have been present between discs of the same patient. Results: The mean age of the participant was 14 years, and the mean curvature before and after surgery were 67.8 and 23.8, respectively (p<0.05). During the median follow-up of 5 years, the mean degree of the disc degeneration significantly increased in all patients after surgery (p<0.05) with a Pfirrmann grade of 1 and 2.8 in the L2-L3 before and after surgery, respectively. The corresponding figures at L3-L4, L4-L5, and L5-S1 levels were 1.28 and 2.43, 1.07 and 2.35, and 1 and 2.33, respectively. The lower was the number of free discs below the fusion level, the higher was the Pfirrmann grade of degeneration (p<0.001). Conversely, the higher was the number of the discs fused together, the higher was the Pfirrmann grade. Conclusions: we observed that the disc degeneration aggravated after spinal fusion for scoliosis. While the degree of degeneration as measured by Pfirrmann grade was directly correlated by the number of fused segments, it was negatively correlated with the number of discs that remained free below the lowermost level of the fusion.

Keywords

References

  1. Akazawa T, Kotani T, Sakuma T, et al. Spinal fusion on adolescent idiopathic scoliosis patients with the level of L4 or lower can increase lumbar disc degeneration with sagittal imbalance 35 years after surgery. Spine Surg Relat Res 2017;1:72-7. https://doi.org/10.22603/ssrr.1.2016-0017
  2. Yang JY, Lee JK, Song HS. The impact of adjacent segment degeneration on the clinical outcome after lumbar spinal fusion. Spine (Phila Pa 1976) 2008;33:503-7. https://doi.org/10.1097/BRS.0b013e3181657dc3
  3. Cochran T, Irstam L, Nachemson A. Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion. Spine (Phila Pa 1976) 1983;8:576-84. https://doi.org/10.1097/00007632-198309000-00003
  4. Adams MA, Roughley PJ. What is intervertebral disc degeneration, and what causes it? Spine (Phila Pa 1976) 2006;31:2151-61. https://doi.org/10.1097/01.brs.0000231761.73859.2c
  5. Stokes IA, Iatridis JC. Mechanical conditions that accelerate intervertebral disc degeneration: overload versus immobilization. Spine (Phila Pa 1976) 2004;29:2724-32. https://doi.org/10.1097/01.brs.0000146049.52152.da
  6. ROAF R. Vertebral growth and its mechanical control. J Bone Joint Surg Br 1960;42-B:40-59. https://doi.org/10.1302/0301-620X.42B1.40
  7. MacMahon PJ, Taylor DH, Duke D, Brennan DD, Eustace SJ. Disc displacement patterns in lumbar anterior spondylolisthesis: contribution to foraminal stenosis. Eur J Radiol 2009;70:149-54. https://doi.org/10.1016/j.ejrad.2007.12.003
  8. Chen IR, Wei TS. Disc height and lumbar index as independent predictors of degenerative spondylolisthesis in middle-aged women with low back pain. Spine (Phila Pa 1976) 2009;34:1402-9. https://doi.org/10.1097/BRS.0b013e31817b8fbd
  9. Cerny P, Marik I, Pallova I. The radiographic method for evaluation of axial vertebral rotation: presentation of the new method. Scoliosis 2014;9:11. https://doi.org/10.1186/1748-7161-9-11
  10. Kim H, Kim HS, Moon ES, et al. Scoliosis imaging: what radiologists should know. Radiographics 2010;30:1823-42. https://doi.org/10.1148/rg.307105061
  11. Lenke LG, Betz RR, Harms J, et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 2001;83-A:1169-81.
  12. Perie D, Curnier D. Effect of pathology type and severity on the distribution of MRI signal intensities within the degenerated nucleus pulposus: application to idiopathic scoliosis and spondylolisthesis. BMC Musculoskelet Disord 2010;11:189. https://doi.org/10.1186/1471-2474-11-189
  13. Driscoll M, Aubin CE, Moreau A, Villemure I, Parent S. The role of spinal concave-convex biases in the progression of idiopathic scoliosis. Eur Spine J 2009;18:180-7. https://doi.org/10.1007/s00586-008-0862-z
  14. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 2001;26:1873-8. https://doi.org/10.1097/00007632-200109010-00011
  15. Khodair SA, Ghieda UE, Eltomey MA. Relationship of lumbosacral spine morphometrics and lumber disc degenerative disease in young adults using magnetic resonance imaging. Egypt J Radiol Nucl Med 2014;45:461-6. https://doi.org/10.1016/j.ejrnm.2014.02.005
  16. Chen WJ, Lai PL, Chen LH. Adjacent instability after instrumented lumbar fusion. Chang Gung Med J 2003;26:792-8.
  17. Lee JC, Choi SW. Adjacent segment pathology after lumbar spinal fusion. Asian Spine J 2015;9:807-17. https://doi.org/10.4184/asj.2015.9.5.807
  18. Harrop JS, Youssef JA, Maltenfort M, et al. Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine (Phila Pa 1976) 2008;33:1701-7. https://doi.org/10.1097/BRS.0b013e31817bb956
  19. Lund T, Oxland TR. Adjacent level disk disease: is it really a fusion disease? Orthop Clin North Am 2011;42:529-41. https://doi.org/10.1016/j.ocl.2011.07.006
  20. Takahashi S, Delecrin J, Passuti N. Changes in the unfused lumbar spine in patients with idiopathic scoliosis: a 5- to 9-year assessment after cotrel-dubousset instrumentation. Spine (Phila Pa 1976) 1997;22:517-23. https://doi.org/10.1097/00007632-199703010-00009
  21. Schulte TL, Leistra F, Bullmann V, et al. Disc height reduction in adjacent segments and clinical outcome 10 years after lumbar 360 degrees fusion. Eur Spine J 2007;16:2152-8. https://doi.org/10.1007/s00586-007-0515-7
  22. Sears WR, Sergides IG, Kazemi N, Smith M, White GJ, Osburg B. Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis. Spine J 2011;11:11-20. https://doi.org/10.1016/j.spinee.2010.09.026
  23. Aota Y, Kumano K, Hirabayashi S. Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J Spinal Disord 1995;8:464-73.
  24. Ahn DK, Park HS, Choi DJ, Kim KS, Yang SJ. Survival and prognostic analysis of adjacent segments after spinal fusion. Clin Orthop Surg 2010;2:140-7. https://doi.org/10.4055/cios.2010.2.3.140
  25. Greiner-Perth R, Boehm H, Allam Y, Elsaghir H, Franke J. Reoperation rate after instrumented posterior lumbar interbody fusion: a report on 1680 cases. Spine (Phila Pa 1976) 2004;29:2516-20. https://doi.org/10.1097/01.brs.0000144833.63581.c1
  26. Pellise F, Hernandez A, Vidal X, Minguell J, Martinez C, Villanueva C. Radiologic assessment of all unfused lumbar segments 7.5 years after instrumented posterior spinal fusion. Spine (Phila Pa 1976) 2007;32:574-9. https://doi.org/10.1097/01.brs.0000256875.17765.e6
  27. Wiltse LL, Radecki SE, Biel HM, et al. Comparative study of the incidence and severity of degenerative change in the transition zones after instrumented versus noninstrumented fusions of the lumbar spine. J Spinal Disord 1999;12:27-33.
  28. Ghiselli G, Wang JC, Bhatia NN, Hsu WK, Dawson EG. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am 2004;86-A:1497-503.
  29. Akamaru T, Kawahara N, Tim Yoon S, et al. Adjacent segment motion after a simulated lumbar fusion in different sagittal alignments: a biomechanical analysis. Spine (Phila Pa 1976) 2003;28:1560-6.
  30. Untch C, Liu Q, Hart R. Segmental motion adjacent to an instrumented lumbar fusion: the effect of extension of fusion to the sacrum. Spine (Phila Pa 1976) 2004;29:2376-81. https://doi.org/10.1097/01.brs.0000143667.55696.bd

Cited by

  1. Dynamic Scoliosis Correction as Alternative Treatment for Patients with Adolescent Idiopathic Scoliosis: a Non-Fusion Surgical Technique vol.158, pp.6, 2018, https://doi.org/10.1055/a-0983-1265
  2. Measurable Thoracic Motion Remains at 1 Year Following Anterior Vertebral Body Tethering, with Sagittal Motion Greater Than Coronal Motion vol.103, pp.24, 2018, https://doi.org/10.2106/jbjs.20.01533
  3. Treatment of ‘Suicidal Jumper Fractures’ with Lumbopelvic Fixation: A Report of Nine Cases vol.30, pp.2, 2021, https://doi.org/10.2485/jhtb.30.205