Adjacent segment disk degeneration three decades after fusion without attempted reduction for high-grade isthmic spondylolisthesis

• Study design: Observational study. Objectives: To evaluate adjacent segment disk degeneration (ASD) after fusion without attempted reduction at a young age for high-grade isthmic spondylolisthesis. Summary of background data: The clinical relevance of ASD remains unclear. Previous studies have shown that spinal fusion is associated with increased ASD but without influence on clinical outcome. Since high-grade spondylolisthesis is a severe kyphotic deformity, one could hypothesize that fusion without attempted reduction in young patients leads to accelerated adjacent segment disk degeneration in adult life. Methods: Anterior and posterior disk heights were evaluated on supine radiographs of the spine 8years and 29years after fusion without attempted reduction for high-grade spondylolisthesis and also on standing radiographs 8years and 33years after surgery. Pelvic parameters were evaluated on standing radiographs obtained 33years after surgery. Health-related quality of life was evaluated with the Scoliosis Research Society (SRS)-22r questionnaire. Results: One segment above fusion the anterior disk height significantly decreased on standing radiographs. Two segments above the fusion, the anterior disk height significantly decreased on supine as well as on standing radiographs. The largest reduction was found two segments above the fusion where the disk height was reduced from 33 to 28% of anterior vertebral height between the measurements at mean 8years and mean 33years after surgery. There were no statistically significant decreases in posterior disk heights in any measurement. The disk height showed a moderate negative correlation to PT. There was no correlation between disk height reduction and SRS-22r outcome. Conclusions: In our long-term follow-up of fusion without attempted reduction for high-grade spondylolisthesis in young patients, we found only a minor but statistically significant reduction in adjacent segment disk height which had no apparent impact on clinical outcome. Level of evidence: Level IV. © 2020, Scoliosis Research Society.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Ortopedi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Orthopaedics (hsv//eng)

Nyckelord

Adjacent segment disk degeneration

Disk height

Fusion without attempted reduction

Spondylolisthesis

SRS-22

Adjacent segment disk degeneration

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)