Repeat fusion may increase rates of adjacent segment disease needing revision

NEW ORLEANS – A repeat fusion may negatively affect the pelvic incidence-lumbar lordosis match in a patient, which can then lead to adjacent segment disease requiring revision surgery, a speaker said here.

For every degree of pelvic incidence-lumbar lordosis (PI-LL) mismatch in a patient, the chances of developing adjacent segment disease (ASD) requiring revision surgery increase by more than 1.4-fold, said David O. Okonkwo, MD, PhD, at the Congress of Neurological Surgeons Annual Meeting.

Okonkwo described a 59-year-old patient, who came into his institution 3 years after undergoing an L5-S1 fusion, with severe back pain. He failed conservative management of his pain, Okonkwo said.

“I extended his fusion up a level. This worsened his lordosis and pelvic incidence. His PI-LL mismatch went out to 34°, which in our series was a 100% chance of developing ASD. He had the ASD in 2 years,” Okonkwo said.

The repeat lumbar fusion increased the patient’s PI-LL mismatch and increased his chances of developing ASD in need of revision surgery. Okonkwo and colleagues determined a threshold for PI-LL mismatch of 12° was an independent risk factor for ASD revision surgery.

Looking back on the patient, Okonkwo said an ALIF procedure may have been a better option. – by Robert Linnehan

Reference: Okonkwo DO. Paper: Lumbar: Repeat Fusion. Presented at: Congress of Neurological Surgeons Annual Meeting; Sept. 26-30, 2015; New Orleans.

Disclosure: Okonkwo reports receiving no relevant financial disclosures.