The Importance of Preserving the Posterior Ligament Complex in Elective Lumbar Fusion Surgery: Early Results from a Single-Center Experience.
Publication Title
Cureus
Document Type
Article
Publication Date
12-1-2024
Keywords
adjacent segment disease; decompression; laminectomy; lumbar fusion; posterior ligamentous complex; washington; swedish; swedish neurosci
Abstract
BACKGROUND: Adjacent segment disease (ASD) is a degenerative condition at the segment adjacent to a previously fused segment. Potential risk factors for ASD, such as posterior ligamentous complex (PLC) integrity between the upper instrumented vertebra (UIV) and the first unfused segment (UIV+1), have not been addressed. The objective of this study is to assess the PLC integrity between the UIV and UIV+1 following posterior lumbar decompression and fusion (PLDF).
METHODS: A retrospective review of 122 patients who received a PLDF was performed. Patients were divided into groups based on the integrity of the PLC between the UIV and the UIV+1: PLC disrupted and PLC intact. The development of ASD was assessed using standard radiographic parameters, and reoperation rates were reviewed.
RESULTS: Radiographic indicators for ASD were more common in patients of the PLC-deficient group-D and showed significantly higher mobility at the UIV+1 (p < 0.05). The overall surgical revision rate due to ASD was 7.4%, with group D (28 patients) exceeding the revision rate of group I (94 patients) by 4.3% (10.7% vs. 6.4%) over a mean follow-up of three years. The mean return to the operative report time at the UIV+1 was 2.4 years (± 1.7 years) after index surgery.
CONCLUSION: We demonstrated a significant increase in mobility at the UIV+1 in lumbar fusion in patients with disrupted PLC. PLC deficiency at UIV+1 appears to contribute to the development of ASD through instability and is implicated in higher surgical revision rates.
Area of Special Interest
Neurosciences (Brain & Spine)
Area of Special Interest
Orthopedics & Sports Medicine
Specialty/Research Institute
Neurosciences
Specialty/Research Institute
Orthopedics
DOI
10.7759/cureus.76252
