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Adjacent segment hypermobility after lumbar spine fusion: No association with progressive degeneration of the segment 5 years after surgery.

Axelsson, Paul LU ; Johnsson, Ragnar LU and Strömqvist, Björn LU (2007) In Acta Orthopaedica 78(6). p.834-839
Abstract
Background and purpose Increased intradiscal pressure and relative segmental hypermobility are in vitro observations supporting the idea of increased postoperative load being a reason for progressive degeneration of the free mobile segment adjacent to a lumbar fusion. These mechanisms have been difficult to confirm in clinical studies, and an alternative theory claims instead that the adjacent segment degeneration follows a natural degenerative course in patients who are predisposed. We examined 9 patients 5 years after lumbar fusion, to assess whether relative hypermobility of the segment adjacent to fusion could be correlated to progressive degeneration of the same segment. Patients and methods The 9 patients, all of whom had been... (More)
Background and purpose Increased intradiscal pressure and relative segmental hypermobility are in vitro observations supporting the idea of increased postoperative load being a reason for progressive degeneration of the free mobile segment adjacent to a lumbar fusion. These mechanisms have been difficult to confirm in clinical studies, and an alternative theory claims instead that the adjacent segment degeneration follows a natural degenerative course in patients who are predisposed. We examined 9 patients 5 years after lumbar fusion, to assess whether relative hypermobility of the segment adjacent to fusion could be correlated to progressive degeneration of the same segment. Patients and methods The 9 patients, all of whom had been treated with a lumbar fusion after a preoperative intervertebral mobility assessment by spinal RSA, were re-examined 5 years after surgery. The intervertebral translations of the vertebra proximal to the fusion were determined by RSA and compared to the mobility of the same lumbar segment before fusion. The disc height and any progressive reduction at the two levels proximal to the one fused were measured on conventional radiographs. Results Adjacent segment mobility 5 years after fusion - expressed as mean transverse, vertical, and sagittal translation of the vertebra proximal to fusion - was not significantly changed compared to the mobility measured before surgery. Increased mobility of the segment seen in 5 individual patients was not associated with progressive degeneration of the same segment or to a poor clinical outcome. Interpretation Hypermobility of the segment adjacent to fusion is not a general finding. Increased mobility that can be seen in certain individuals does not impair the 5-year result. The significance of mechanical alterations in adjacent segment degeneration is uncertain, and it is possibly overestimated. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Orthopaedica
volume
78
issue
6
pages
834 - 839
publisher
Taylor & Francis
external identifiers
  • PMID:18236192
  • WOS:000252849000017
  • Scopus:38749141386
ISSN
1745-3682
DOI
10.1080/17453670710014635
language
English
LU publication?
yes
id
382fcf64-59e3-430d-8c92-ba707dbef855 (old id 1042434)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18236192?dopt=Abstract
date added to LUP
2008-03-03 13:25:38
date last changed
2016-10-13 04:27:34
@misc{382fcf64-59e3-430d-8c92-ba707dbef855,
  abstract     = {Background and purpose Increased intradiscal pressure and relative segmental hypermobility are in vitro observations supporting the idea of increased postoperative load being a reason for progressive degeneration of the free mobile segment adjacent to a lumbar fusion. These mechanisms have been difficult to confirm in clinical studies, and an alternative theory claims instead that the adjacent segment degeneration follows a natural degenerative course in patients who are predisposed. We examined 9 patients 5 years after lumbar fusion, to assess whether relative hypermobility of the segment adjacent to fusion could be correlated to progressive degeneration of the same segment. Patients and methods The 9 patients, all of whom had been treated with a lumbar fusion after a preoperative intervertebral mobility assessment by spinal RSA, were re-examined 5 years after surgery. The intervertebral translations of the vertebra proximal to the fusion were determined by RSA and compared to the mobility of the same lumbar segment before fusion. The disc height and any progressive reduction at the two levels proximal to the one fused were measured on conventional radiographs. Results Adjacent segment mobility 5 years after fusion - expressed as mean transverse, vertical, and sagittal translation of the vertebra proximal to fusion - was not significantly changed compared to the mobility measured before surgery. Increased mobility of the segment seen in 5 individual patients was not associated with progressive degeneration of the same segment or to a poor clinical outcome. Interpretation Hypermobility of the segment adjacent to fusion is not a general finding. Increased mobility that can be seen in certain individuals does not impair the 5-year result. The significance of mechanical alterations in adjacent segment degeneration is uncertain, and it is possibly overestimated.},
  author       = {Axelsson, Paul and Johnsson, Ragnar and Strömqvist, Björn},
  issn         = {1745-3682},
  language     = {eng},
  number       = {6},
  pages        = {834--839},
  publisher    = {ARRAY(0x8463a88)},
  series       = {Acta Orthopaedica},
  title        = {Adjacent segment hypermobility after lumbar spine fusion: No association with progressive degeneration of the segment 5 years after surgery.},
  url          = {http://dx.doi.org/10.1080/17453670710014635},
  volume       = {78},
  year         = {2007},
}