• W J Chen, P L Lai, C C Niu, L H Chen, T S Fu, and C B Wong.
• Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. chenwenj@adm.cgmh.org.tw
• Spine. 2001 Nov 15; 26 (22): E519-24.

Study DesignThis study is a retrospective review of 39 patients with previous instrumented lumbar fusion who underwent secondary spine surgery for lumbar adjacent instability. To the authors' knowledge, this is the largest study of surgical treatment of lumbar adjacent instability in the literature to date.ObjectThis study evaluated the feasibility of adjacent instability treated with medial facetectomy, fusion with autologous bone grafting, and pedicle screw instrumentation.Summary Of Background DataThe surgical treatment of adjacent instability has seldom been discussed. Revision spine fusions are challenged by high pseudarthrosis rates.MethodsThirty-nine patients with previous lumbar fusion underwent second lumbar spine surgery for adjacent instability. All were treated with autogenous posterolateral arthrodesis and transpedicle screw fixation in addition to decompressive laminectomy. Medical records, radiographs, and pain scores were obtained.ResultsThe clinical results were excellent or good in 76.9% of patients, and the radiographic fusion was successful in 37 (94.9%) of patients. Flat back was noted in 8 (20.5%) of patients. In 5 patients (12.8%), neighboring segment breakdown again developed, and 2 of those patients underwent a third lumbar fusion. Dural tear during operation occurred in 2 patients. One patient experienced cauda equina syndrome but recovered bladder function 1 month later.ConclusionAutogenous posterolateral arthrodesis combined with pedicle screw fixation led to successful radiologic and clinical outcome in patients with lumbar adjacent instability. Adequate decompression of the adjacent stenosis requires medial facetectomy, thus preventing aggressive nerve root manipulation and reducing the incidence of dural tear.

23 keywords...

hide…