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Multilevel decompression not linked to higher risk of adjacent segment disease
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SAN DIEGO — Decompression of additional lumbar levels above a single-level posterior lumbar fusion did not increase patients’ risk of developing adjacent segment disease, according to a recent presentation.
Brian J. Neuman, MD, shared his group’s findings at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons in San Diego.
“There is some debate in the literature on how you should treat multilevel stenosis with a single-level spondylolisthesis,” Neuman said. “Is there an increased risk of adjacent segment disease (ASD) if a single-level is fused? To date, there is no guidance in the literature on how to treat this pathology.”
The study’s aim, Neuman reported, was to evaluate the impact of multilevel decompression in a single-level fusion on the patient’s risk of developing ASD.
A retrospective chart review
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Neuman’s group performed a retrospective chart review of 183 consecutive patients who underwent a single-level posterior lumbar fusion for spondylolisthesis with stenosis. In all, 142 patients met the minimum 24-month follow-up, with 58 of the patients undergoing a posterior lumbar fusion with decompression in additional levels above the fusion. The other 84 patients underwent a single-level laminectomy with posterior lumbar fusion.
ASD incidence and reoperation rates were recorded, and the investigators used Fisher’s exact test to compare subgroups. For the purpose of the study, ASD was defined in the abstract as “the development of new radiculopathy or claudication referable to a motion segment adjacent to the lumbar arthrodesis with symptom duration greater than 6 weeks.”
No significant differences
Neuman reported 22.4% (13 of 58) of patients who underwent a posterior lumbar fusion with multilevel laminectomy developed ASD. There was a 5.2% (3 of 58) reoperation rate. Patients who underwent posterior lumbar fusion with a laminectomy at only the fusion level demonstrated a 14.3% (12 of 84) rate of ASD, with a reoperation rate of 7.1% (6 of 84).
The results, according to the study, point toward neither a significantly higher incidence of ASD or reoperation rate between the multilevel and single-level laminectomy groups.
“More patients who underwent a multilevel laminectomy above a single-level fusion developed [ASD], but more patients with a single-level laminectomy at the site of fusion required surgery,” Neuman concluded. “However, these differences are small and not statistically significant.”
“Additional levels decompressed above a fusion do not carry significant risk of [ASD] or an increased reoperation rate,” he added.
Reference:
- Neuman BJ, et al. Does a multilevel laminectomy with a single level PLF increase the risk of adjacent segment disease. Paper #256. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.
- Disclosure: Neuman has no relevant financial disclosures.
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