The effect of preoperative diagnosis on the incidence of adjacent segment disease after lumbar fusion

Rafael De La Garza-Ramos, Panagiotis Kerezoudis, Daniel Sciubba, Ali Bydon, Timothy F Witham, Mohamad Bydon

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The aim of this study was to determine the incidence of adjacent segment disease (ASD) requiring reoperation after lumbar fusion and to compare survivorship of adjacent levels according to preoperative diagnosis. METHODS: Two hundred and seventy five patients who underwent instrumented posterolateral fusion of the lumbar spine without an interbody device were included. Patients were stratified by preoperative diagnoses (lumbar spinal stenosis, spondylolisthesis, or postlaminectomy revision) and were followed for an average time of 59 months. The incidence of ASD requiring reoperation was calculated via Kaplan-Meier survivorship analysis. A Cox-proportional hazards regression analysis was performed to identify the independent impact of preoperative diagnosis, age, sex, and number of segments fused on ASD development. RESULTS: A total of 59 (21.5%) patients required reoperation for ASD. Following Kaplan-Meier analysis, the predicted ASD-free survival was 79.7% (95% CI, 72.3-85.3) at 5 years and 53.4% (95% CI, 40.0-65.0) at 10 years. Moreover, the incidence was not significantly different between diagnostic subgroups by the log-rank test (P=0.144). Following risk factor analysis, the only significant factor associated with ASD was increasing age (RR 1.02; 95% CI, 1.00-1.05). Male sex, preoperative diagnosis, and the numbers of segments fused were not significantly associated with ASD. CONCLUSIONS: Few studies to date have specifically investigated the influence of pre-operative diagnosis on lumbar fusion outcomes. The incidence of ASD requiring reoperation was estimated at 20.3% and 45.7% at 5 and 10 years, respectively. In this study, the incidences of ASD based on preoperative diagnosis were not significantly different between groups; the only significant risk factor was increasing age.

Original languageEnglish (US)
Pages (from-to)4-9
Number of pages6
JournalJournal of Neurosurgical Sciences
Volume62
Issue number1
DOIs
StatePublished - Feb 1 2018

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Incidence
Reoperation
Kaplan-Meier Estimate
Survival Rate
Spondylolisthesis
Spinal Stenosis
Statistical Factor Analysis
Disease-Free Survival
Spine
Regression Analysis
Equipment and Supplies

Keywords

  • Aging
  • Diagnosis
  • Reoperation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The effect of preoperative diagnosis on the incidence of adjacent segment disease after lumbar fusion. / De La Garza-Ramos, Rafael; Kerezoudis, Panagiotis; Sciubba, Daniel; Bydon, Ali; Witham, Timothy F; Bydon, Mohamad.

In: Journal of Neurosurgical Sciences, Vol. 62, No. 1, 01.02.2018, p. 4-9.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: The aim of this study was to determine the incidence of adjacent segment disease (ASD) requiring reoperation after lumbar fusion and to compare survivorship of adjacent levels according to preoperative diagnosis. METHODS: Two hundred and seventy five patients who underwent instrumented posterolateral fusion of the lumbar spine without an interbody device were included. Patients were stratified by preoperative diagnoses (lumbar spinal stenosis, spondylolisthesis, or postlaminectomy revision) and were followed for an average time of 59 months. The incidence of ASD requiring reoperation was calculated via Kaplan-Meier survivorship analysis. A Cox-proportional hazards regression analysis was performed to identify the independent impact of preoperative diagnosis, age, sex, and number of segments fused on ASD development. RESULTS: A total of 59 (21.5{\%}) patients required reoperation for ASD. Following Kaplan-Meier analysis, the predicted ASD-free survival was 79.7{\%} (95{\%} CI, 72.3-85.3) at 5 years and 53.4{\%} (95{\%} CI, 40.0-65.0) at 10 years. Moreover, the incidence was not significantly different between diagnostic subgroups by the log-rank test (P=0.144). Following risk factor analysis, the only significant factor associated with ASD was increasing age (RR 1.02; 95{\%} CI, 1.00-1.05). Male sex, preoperative diagnosis, and the numbers of segments fused were not significantly associated with ASD. CONCLUSIONS: Few studies to date have specifically investigated the influence of pre-operative diagnosis on lumbar fusion outcomes. The incidence of ASD requiring reoperation was estimated at 20.3{\%} and 45.7{\%} at 5 and 10 years, respectively. In this study, the incidences of ASD based on preoperative diagnosis were not significantly different between groups; the only significant risk factor was increasing age.",
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AU - De La Garza-Ramos, Rafael

AU - Kerezoudis, Panagiotis

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AU - Witham, Timothy F

AU - Bydon, Mohamad

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N2 - BACKGROUND: The aim of this study was to determine the incidence of adjacent segment disease (ASD) requiring reoperation after lumbar fusion and to compare survivorship of adjacent levels according to preoperative diagnosis. METHODS: Two hundred and seventy five patients who underwent instrumented posterolateral fusion of the lumbar spine without an interbody device were included. Patients were stratified by preoperative diagnoses (lumbar spinal stenosis, spondylolisthesis, or postlaminectomy revision) and were followed for an average time of 59 months. The incidence of ASD requiring reoperation was calculated via Kaplan-Meier survivorship analysis. A Cox-proportional hazards regression analysis was performed to identify the independent impact of preoperative diagnosis, age, sex, and number of segments fused on ASD development. RESULTS: A total of 59 (21.5%) patients required reoperation for ASD. Following Kaplan-Meier analysis, the predicted ASD-free survival was 79.7% (95% CI, 72.3-85.3) at 5 years and 53.4% (95% CI, 40.0-65.0) at 10 years. Moreover, the incidence was not significantly different between diagnostic subgroups by the log-rank test (P=0.144). Following risk factor analysis, the only significant factor associated with ASD was increasing age (RR 1.02; 95% CI, 1.00-1.05). Male sex, preoperative diagnosis, and the numbers of segments fused were not significantly associated with ASD. CONCLUSIONS: Few studies to date have specifically investigated the influence of pre-operative diagnosis on lumbar fusion outcomes. The incidence of ASD requiring reoperation was estimated at 20.3% and 45.7% at 5 and 10 years, respectively. In this study, the incidences of ASD based on preoperative diagnosis were not significantly different between groups; the only significant risk factor was increasing age.

AB - BACKGROUND: The aim of this study was to determine the incidence of adjacent segment disease (ASD) requiring reoperation after lumbar fusion and to compare survivorship of adjacent levels according to preoperative diagnosis. METHODS: Two hundred and seventy five patients who underwent instrumented posterolateral fusion of the lumbar spine without an interbody device were included. Patients were stratified by preoperative diagnoses (lumbar spinal stenosis, spondylolisthesis, or postlaminectomy revision) and were followed for an average time of 59 months. The incidence of ASD requiring reoperation was calculated via Kaplan-Meier survivorship analysis. A Cox-proportional hazards regression analysis was performed to identify the independent impact of preoperative diagnosis, age, sex, and number of segments fused on ASD development. RESULTS: A total of 59 (21.5%) patients required reoperation for ASD. Following Kaplan-Meier analysis, the predicted ASD-free survival was 79.7% (95% CI, 72.3-85.3) at 5 years and 53.4% (95% CI, 40.0-65.0) at 10 years. Moreover, the incidence was not significantly different between diagnostic subgroups by the log-rank test (P=0.144). Following risk factor analysis, the only significant factor associated with ASD was increasing age (RR 1.02; 95% CI, 1.00-1.05). Male sex, preoperative diagnosis, and the numbers of segments fused were not significantly associated with ASD. CONCLUSIONS: Few studies to date have specifically investigated the influence of pre-operative diagnosis on lumbar fusion outcomes. The incidence of ASD requiring reoperation was estimated at 20.3% and 45.7% at 5 and 10 years, respectively. In this study, the incidences of ASD based on preoperative diagnosis were not significantly different between groups; the only significant risk factor was increasing age.

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