The Risk Factors for Early-onset Adjacent Segment Disease in Patients With Spondylolytic Spondylolisthesis Who Underwent Single-level Posterior Lumbar Interbody Fusion — The International Society for the Study of the Lumbar Spine
  1. Schedule
  2. GENERAL POSTERS ON-LINE
  3. The Risk Factors for Early-onset Adjacent Segment Disease in Patients With Spondylolytic Spondylolisthesis Who Underwent Single-level Posterior Lumbar Interbody Fusion

The Risk Factors for Early-onset Adjacent Segment Disease in Patients With Spondylolytic Spondylolisthesis Who Underwent Single-level Posterior Lumbar Interbody Fusion (#1231)

Kazuki Takeda 1 2 3 , Satoshi Suzuki 2 3 , Yohei Takahashi 2 3 , Satoshi Nori 2 3 , Osahiko Tsuji 2 3 , Narihito Nagoshi 2 3 , Mitsuru Yagi 2 3 , Masahiro Ozaki 3 4 , Hitoshi Kono 3 4 , Nobuyuki Fujita 3 5 , Morio Matsumoto 2 , Masaya Nakamura 2 , Kota Watanabe 2 3
  1. Department of Orthopaedic Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan
  2. Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku,, TOKYO, Japan
  3. Keio Spine Research Group, Tokyo
  4. Department of Orthopaedic Surgery, Medical Corporation Keiyukai Keiyu Orthopaedic Hospital, Gunma
  5. Department of Orthopaedic Surgery, Fujita Health University Hospital, Aichi

Background

The risk factors for radiographical adjacent segment disease (ASD) in patients with degenerative spondylolisthesis have been reported. However, reports on patients with spondylolytic spondylolisthesis who underwent single-level posterior lumbar interbody fusion (PLIF) are few.This study aims to investigate the risk factors for radiographical ASD in patients with L5-S1 spondylolytic spondylolisthesis who underwent single-level PLIF.

Methods

This study retrospectively reviewed 135 consecutive symptomatic L5-S1 spondylolytic spondylolisthesis (91 males and 44 females) who underwent single-level PLIF. The mean age at surgery and mean follow-up period were 58.5 ± 15.0 years and 30.3 ± 10.1 months, respectively. Radiographical ASD was defined as disc height loss (>3 mm), posterior angulation increase (>5°), or progression of slippage for anterior translation (>3 mm) between the pre- and postoperative radiographs. Disc degeneration was evaluated using Pfirrmann’s classification. The changes between the pre- and postoperative values were evaluated in each non-ASD and ASD group. We compared radiographical parameters between non-ASD and ASD group. A binary logistic regression model was conducted to evaluate the adjusted associations between each potential explanatory variable and ASD development. The pre- and postoperative (at the final follow-up) global sagittal alignment, % slip, sacral slope (SS), lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), PI minus LL (PI-LL), lumbosacral angle (LSA), C7 sagittal vertical axis (C7-SVA), and thoracic kyphosis (TK) on the standing radiographs were measured.

 

Results

Radiographical ASD incidence was 11%. Also, 60.0% of the patients with ASD had radiographical ASD at 1 year after the initial surgery and all cases of radiographical ASD in this follow-up period occurred within 3 years after the initial surgery. The mean period of ASD occurrence after initial surgery was 21.7 ± 12.6 months. No patients required reoperation for radiographical ASD. Multivariate analysis revealed that preoperative pelvic incidence (PI) minus lumbar lordosis (LL) ≥ 15° (odds ratio [OR], 5.9; 95% confidence interval [CI], 1.2–28.9; p = 0.03) and postoperative PI-LL ≥ 15° (OR, 6.5; 95% CI, 1.2–34.5; p = 0.03) were the risk factors for radiographical ASD.

Conclusions

the current study identified that the pre- and postoperative PI-LL mismatch ≥ 15° were the independent risk factors for early-onset radiographical ASD in patients with L5-S1 spondylolytic spondylolisthesis who underwent single-level PLIF. Therefore, the sagittal alignment, particularly the risk factor identified in the present study, should be taken into consideration when surgeons decide the surgical approach for L5-S1 spondylolytic spondylolisthesis.

#ISSLS2022