The Causes of Revision Arthrodesis for the Degenerative Changes at the Adjacent Segment after Lumbosacral Fusion for Degenerative Lumbar Diseases

Abstract

Study Design: A Retrospective study Objectives: To analyze the causes of revision arthrodesis for the degenerative changes at the adjacent segment after lumbosacral fusion for degenerative lumbar diseases. Summary of Literature Review: Revision arthrodesis is quite common. However, there is some controversy regarding the causes and risk factors. Materials and Methods: Twenty cases who had undergone revision arthrodesis after lumbosacral fusion were examined. Preexisting degenerative changes to the adjacent segment, location of the adjacent segment and extent of fusion, as well as changes in lumbar lordosis were observed in primary arthrodesis, and the relationship between the changes in the adjacent segment degeneration were analyzed in terms of the area of residence, activity level and living pattern of the patients. Results: Preexisting degenerative changes in the adjacent segment were observed in 14 cases and degenerative changes developed at the proximal junction in 19. Multiple segment fusion were performed in 13 cases during primary arthrodesis, 9 cases developed degenerative changes at the proximal junction. Fifteen cases with abnormal postoperative lumbar lordosis demonstrated adjacent segment degeneration. Sixteen cases living in the countryside and 15 cases with a history of severe physical labor after the primary operation showed degenerative changes in the adjacent segment before secondary arthrodesis. Conclusion: The causes of revision arthrodesis for the degenerative changes at the adjacent segment are believed to be preexisting degenerative changes in the adjacent segment at the proximal junction, loss of lordosis after primary fusion, and severe physical labor from living in the countryside