Risk factors for early-onset radiographical adjacent segment disease in patients with spondylolytic spondylolisthesis after single-level posterior lumbar interbody fusion

Abstract

BACKGROUND CONTEXTThe risk factors for radiographical adjacent segment disease (ASD) in patients with degenerative spondylolisthesis have been previously reported. However, there are only few reports on patients with spondylolytic spondylolisthesis who underwent single-level posterior lumbar interbody fusion (PLIF). PURPOSEThe study aimed to investigate the risk factors for radiographical ASD in patients with L5–S1 spondylolytic spondylolisthesis who underwent single-level PLIF. STUDY DESIGN/SETTINGA retrospective study PATIENT SAMPLEThis study retrospectively reviewed 135 consecutive patients (91 men and 44 women) with symptomatic L5–S1 spondylolytic spondylolisthesis who underwent single-level PLIF. OUTCOME MEASURESThe pre- and postoperative (at the final follow-up) spinopelvic parameters, % slip, sacral slope, lumbar lordosis (LL), pelvic tilt, pelvic incidence (PI), PI minus LL (PI − LL), lumbosacral angle, C7 sagittal vertical axis, and thoracic kyphosis were measured using standing radiographs. METHODSRadiographical ASD was defined as disc height loss (>3 mm), increase of posterior angulation (>5°), or progression of spondylolisthesis (>3 mm) between the pre- and postoperative radiographs. Pfirrmann's classification was used to evaluate disc degeneration. The radiographical parameters and changes between the pre- and postoperative values were evaluated and compared for the non-ASD and ASD groups. Binary logistic regression analysis was performed to evaluate the adjusted associations between each potential explanatory variable and ASD development. RESULTSThe radiographical ASD incidence was 11%. Additionally, 60% of the patients with ASD had radiographical ASD at 1 year and all cases of radiographical ASD in this follow-up period occurred within 3 years after the initial surgery. The mean period of ASD occurrence after initial surgery was 21.7 ± 12.6 months. No patients required reoperation for radiographical ASD. Multivariate analysis revealed that a preoperative (odds ratio [OR], 5.9; 95% confidence interval [CI], 1.2–28.9; p=.03) and a postoperative (OR, 6.5; 95% CI, 1.2–34.5; p=.03) PI − LL of ≥15° were risk factors for radiographical ASD. CONCLUSIONSPre- and postoperative PI − LL value mismatch was identified as significant independent risk factors for radiographical ASD in patients with L5–S1 spondylolytic spondylolisthesis. Obtaining larger lordosis at L5–S1 may be the key to preventing radiographical ASD.