2022

Toivonen, Leevi A.; Mäntymäki, Heikki; Häkkinen, Arja; Kautiainen, Hannu; Neva, Marko H.

Objective: We aim to compare the rate of revisions for adjacent segment disease (ASD) after lumbar spine fusion (LSF) surgery between patients with isthmic spondylolisthesis (IS) and degenerative lumbar spine disorders (DLSD). Summary of Background Data: ASD is a major reason for late reoperations after LSF surgery. Several risk factors are linked to the progression of ASD, but the understanding of the underlying mechanisms is imperfect. If IS infrequently becomes complicated with ASD, it would emphasize the role of the ongoing degenerative process in spine in the development of ASD. Methods: 365 consecutive patients that underwent elective LSF surgery were followed up for an average of 9.7 years. Surgical indications were classified into 1) IS (n=64), 2) DLSD (spinal stenosis with or without spondylolisthesis) (n=222), and 3) other reasons (deformities, postoperative conditions after decompression surgery, posttraumatic conditions) (n=79). All spinal reoperations were collected from hospital records. Rates of revisions for ASD were determined using Kaplan-Meier methods. Results: Altogether, 65 (17.8%) patients were reoperated for ASD. The incidences of revisions for ASD in subgroups were 1) 4.8% (95% CI: 1.6 to 22.1%); 2) 20.5% (95% CI: 15.6 to 26.7%); 3) 20.6% (95% CI: 12.9 to 31.9%). After adjusting the groups by age, sex, fusion length, and the level of the caudal end of fusion, when comparing with IS group, the other groups had significantly higher hazard ratios (HR) for the revision for ASD [2) HR (95% CI) 3.92 (1.10 to 13.96), p=0.035], [3) HR (95% CI) of 4.27 (1.11 to 15.54), p=0.036]. Conclusions: Among patients with IS, the incidence of revisions for ASD was less than a 4th of that with DLSD. Efforts to prevent the acceleration of the degenerative process at the adjacent level of fusion are most important with DLSD.