Sublaminar wiring stabilization to prevent adjacent segment degeneration after lumbar spinal fusion |
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Authors: | Hiroyasu Ogawa Hirohiko Hori Hidefumi Oshita Atsushi Akaike Yoshinari Koyama Takashi Shimizu Kazunari Yamada Daich Ishimaru |
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Institution: | (1) Department of Orthopaedic Surgery, Gifu University School of Medicine, 1-1, Yanagido, Gifu Gifu, 501-1194, Japan;(2) Department of Orthopaedic Surgery, Hikone Municipal Hospital, Shiga, Japan;(3) Department of Orthopaedic Surgery, Ohta Hospital, Gifu, Japan;(4) Department of Orthopaedic Surgery, Kizawa Memorial Hospital, Gifu, Japan |
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Abstract: | Introduction Adjacent segment degeneration (ASD) is a complication of lumbar spinal fusion. There are some reports on the cause of this
degeneration but none concerning its prevention. We performed sublaminar wiring stabilization to prevent ASD after posterolateral
lumbar spinal fusion with instrumentation. The purpose of this study was to prospectively evaluate the efficacy of this procedure.
Patients and methods Between 2003 and 2004, 54 consecutive patients with lumbar spinal canal stenosis and multilevel instability of the lumbar
spine underwent posterior decompression and posterolateral fusion with instrumentation. The mean age at the time of surgery
was 66.7 ± 1.3 years, and the mean follow-up period was 40.0 ± 1.1 months, with a minimum of 29 months. Twenty-seven of the
patients underwent conventional sublaminar wiring stabilization at the cephalad segment adjacent to the site of fusion to
prevent ASD (group A), and the other 27 patients did not (group B). Some items were assessed, including clinical outcome using
Japanese Orthopaedic Association (JOA) score, sagittal global lumbar alignment, and segmental motion in flexion–extension
radiographs of the cephalad vertebral body adjacent to the site of fusion.
Results There were no significant differences in JOA scores between two groups, but 2 patients in group B underwent subsequent surgery
due to ASD. Sagittal lumbar alignment did not change in group A but was significantly decreased in group B. With respect to
segmental motion in flexion–extension radiographs, group A showed a significant decrease from 6.9° before surgery to 3.4°
after surgery, on the other hand group B showed a significant increase from 5.6° before surgery to 8.4° after surgery.
Conclusions In this study, it was suggested that sublaminar wiring stabilization significantly reduces the range of motion of the adjacent
segment and preserves sagittal lumbar alignment, which lead to prevention of ASD. The clinical outcome of the subsequent surgeries
is relatively poor, so it is important to prevent ASD by any prevention such as sublaminar wiring stabilization. |
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Keywords: | Adjacent segment degeneration Stabilization Lumbar spine Prevention |
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