• Itaru Yugué, Seiji Okada, Muneaki Masuda, Takayoshi Ueta, Takeshi Maeda, and Keiichiro Shiba.
• Department of Orthopaedic Surgery, Japan Labour Health and Welfare Organization Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, Japan. iyugue@orange.ocn.ne.jp.
• Eur Spine J. 2016 May 1; 25 (5): 1542-1549.

PurposeWe determined the incidence of and risk factors for clinical adjacent segment pathology (C-ASP) requiring additional surgeries among patients previously treated with one-segment lumbar decompression and fusion surgery.MethodsWe retrospectively analysed 161 consecutive patients who underwent one-segment lumbar decompression and fusion surgery for L4 degenerative spondylolisthesis. Patient age, sex, body mass index (BMI), facet orientation and tropism, laminar inclination angle, spinal canal stenosis ratio [on myelography and magnetic resonance imaging (MRI)], preoperative adjacent segment instability, arthrodesis type, pseudarthrosis, segmental lordosis at L4-5, and the present L4 slip were evaluated by a log-rank test using the Kaplan-Meier method. A multivariate Cox proportional-hazards model was used to analyse all factors found significant by the log-rank test.ResultsOf 161 patients, 22 patients (13.7 %) had additional surgeries at cranial segments located adjacent to the index surgery's location. Pre-existing canal stenosis ≥47 % at the adjacent segment on myelography, greater facet tropism, and high BMI were significant risk factors for C-ASP. The estimated incidences at 10 years postoperatively for each of these factors were 51.3, 39.6, and 32.5 %, and the risks for C-ASP were 4.9, 3.7, and, 3.1 times higher than their counterparts, respectively. Notably, spinal canal stenosis on myelography, but not on MRI, was found to be a significant risk factor for C-ASP (log-rank test P < 0.0001 and 0.299, respectively).ConclusionsPre-existing spinal stenosis, greater facet tropism, and higher BMI significantly increased C-ASP risk. Myelography is a more accurate method for detecting latent spinal canal stenosis as a risk factor for C-ASP.

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