Abstract
OBJECTIVES: Adjacent segment degeneration (ASDe) and adjacent segment disease (ASDi) are potential long-term complications after lumbar fusion with rigid instrumentation. Dynamic fixation techniques (Topping-off) adjacent to the fused segments have been developed to curtail the risk of ASDe and ASDi. The current study sought to investigate whether the addition of dynamic rod constructs (DRC) in patients with preoperative degeneration in the adjacent disc was effective in reducing the risk of ASDi. METHODS: A retrospective analysis was performed on clinical data of 207 patients with degenerative lumbar disorders (DLD) from January 2012 to January 2019, who underwent posterior transpedicular lumbar fusion (without Topping-off, NoT/O), and posterior dynamic instrumentation with DRC. Clinical and radiological outcomes were evaluated using Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and lumbar radiographs one, three, and 12 months postoperatively and annually. ASDe was defined as disc height collapse > 20% and disc wedging > 5. Patients with confirmed ASDe and aggravation of ODI > 20 or VAS score > 5 at final follow-up were diagnosed as ASDi. The Kaplan-Meier hazard method was used to estimate the cumulative probability of ASDi within 63 months of surgery. RESULTS: Over three years of follow-up, 65 patients in the NoT/O (59.6%) and 52 cases (53.1%) in the DRC groups met the diagnostic criteria for ASDe. Furthermore, 27 (24.8%) patients in the NoT/O group showed ASDi during the follow-up, compared to 14 (14.3%) cases in the DRC group (P=0.059). Revision surgery was performed on 19 individuals in the NoT/O and 8 cases in the DRC groups (P=0.048). The Cox regression model identified a significantly decreased risk of ASDi if DRC was used (Hazard ratio: 0.29; 95% CI: 0.13-0.6). CONCLUSION: Dynamic fixation adjacent to the fused segment is an effective strategy for preventing ASDi in carefully selected individuals with preoperative degenerative changes at the adjacent level.