• Alexander Carl Disch, Werner Schmoelz, Georg Matziolis, Sascha V Schneider, Christian Knop, and Michael Putzier.
• Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Germany. alexander.disch@charite.de
• J Spinal Disord Tech. 2008 Apr 1;21(2):79-85.

Study DesignWe report the long-term outcome after mono-segmental and bisegmental fusions at the lumbar L4-S1 region of the spine.ObjectiveLong-term clinical and radiologic outcome measures were used to determine a lumbar fusion's contribution to degenerative changes in adjacent motion segments (ASD).Summary Of Background DataThe role of low lumbar spinal fusions and their long-term contribution to accelerated degenerative changes in the adjacent motion segments continues to be a subject of controversy.Patients And MethodsWe followed-up 102 patients with an average age of 54 (22 to 78) years and a follow-up time of 14 (3 to 22) years.ResultsOverall results in patients were good, the Oswestry-Disability Index (ODI) showed an average of 26% (0% to 70%) at follow-up, the Visual Analog Scale rose from 2.7 (postoperative) and 2.9 (12 wk follow-up) to 3.6 (latest follow-up) points, respectively. Patient satisfaction with their health-related situation at follow-up was 69% (15% to 100%). Patients who underwent fusions of the segment L5/S1 showed a significant (P<0.05) lower risk for ASD than patients with fusions L4/5 (20% vs. 46%). Compared with L4/5 fusions, bisegmental L4-S1 fusions showed a similar trend (P=0.06) with a lower risk for ASD (24%). Objective and subjective clinical results showed no differences between these groups. Patients suffering from ASD showed significant (P<0.05) reduced sacral inclination and lumbar lordosis angles and also significant (P<0.05) higher ODI values compared with non-ASD patients.ConclusionsWe conclude that floating fusions of single low lumbar segments are more likely to result in ASD and are negatively influenced by sagittal plane abnormalities.

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