Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders: a meta-analysis

Tao Wang, Wenyuan Ding, Tao Wang, Wenyuan Ding

Abstract

Study design: A meta-analysis.

Objective: We performed a meta-analysis to explore the incidence and risk factors of adjacent segment degeneration (ASD) after posterior lumbar fusion surgery.

Methods: An extensive search of the literature was performed in English database of PubMed, Embase, and Cochrane Library, and Chinese database of CNKI and WANFANG (up to May 2020). We collected factors including demographic data, surgical factor, and sagittal parameters. Data analysis was conducted with RevMan 5.3 and STATA 12.0.

Results: Finally, 19 studies were included in the final analysis. In our study, the rate of ASD after posterior lumbar fusion surgery was 18.6% (540 of 2896). Our data also showed that mean age, body mass index (BMI), the history of smoking and hypertension, preoperative adjacent disc degeneration, long-segment fusion, preoperative superior facet violation, high lumbosacral joint angle, pre- and post-operative L1-S1 sagittal vertical axis (SVA), post-operative lumbar lordosis (LL), and preoperative pelvic incidence (PI) were associated with the development of ASD. However, gender, history of diabetes, bone mineral density (BMD), preoperative Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA), the type of fusion (PLIF vs TLIF), type of bone graft (auto- vs allograft), fusion to S1(vs non-fusion to S1), diagnose (lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis), preoperative pelvic tilt (PT), LL and sacral slope (SS), post-operative SS, PT and PI were not associated with the development of ASD.

Conclusions: In our study, many factors were correlated with the risk of ASD after posterior lumbar fusion surgery. We hope this article can provide a reference for spinal surgeons in treatment for lumbar degenerative diseases.

Keywords: Adjacent segment degeneration; Fusion surgery; Incidence; Lumbar; Meta-analysis; Posterior; Risk factors.

Conflict of interest statement

There are no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of the study selection
Fig. 2
Fig. 2
a The standardized mean difference (SMD) estimate for preoperative age in 2 groups. b The standardized mean difference (SMD) estimate for preoperative body mass index in 2 groups. c The odds ratio (OR) estimate for the history of smoking. CI = confidence interval, df = degrees of freedom, M-H = Mantel–Haenszel
Fig. 3
Fig. 3
a The odds ratio (OR) estimate for gender. b The odds ratio (OR) estimate for the history of diabetes. CI = confidence interval, df = degrees of freedom, M-H=Mantel–Haenszel
Fig. 4
Fig. 4
a The standardized mean difference (SMD) estimate for bone mineral density in 2 groups. b The standardized mean difference (SMD) estimate for preoperative ODI score in 2 groups. c The standardized mean difference (SMD) estimate for preoperative JOA score in 2 groups. df = degrees of freedom, ODI = Oswestry disability index. JOA = Japanese Orthopedic Association, M-H = Mantel–Haenszel
Fig. 5
Fig. 5
a The odds ratio (OR) estimate for the history of hypertension. b The odds ratio (OR) estimate for preoperative Pfirrmann’s classification. c The odds ratio (OR) estimate for the length of fusion (short vs long fusion). CI = confidence interval, df = degrees of freedom, M-H = Mantel–Haenszel
Fig. 6
Fig. 6
a The odds ratio (OR) estimate for preoperative superior facet violation. b The standardized mean difference (SMD) estimate for preoperative lumbar-sacral joint angle in 2 groups. CI = confidence interval, df = degrees of freedom, M-H = Mantel–Haenszel
Fig.7
Fig.7
a The odds ratio (OR) estimate for the type of fusion (PLIF vs TLIP). b The odds ratio (OR) estimate for the type of graft (auto- vs allograft). c The odds ratio (OR) estimate for fusion to S1 (vs non-fusion to S1). CI = confidence interval, df = degrees of freedom, M-H = Mantel–Haenszel
Fig. 8
Fig. 8
a The odds ratio (OR) estimate for diagnosis (lumbar spinal stenosis vs lumbar spondylolisthesis). b The odds ratio (OR) estimate for diagnosis (lumbar disc herniation vs lumbar spinal stenosis). c The odds ratio (OR) estimate for diagnosis (lumbar disc herniation vs lumbar spondylolisthesis). CI = confidence interval, df = degrees of freedom, M-H = Mantel–Haenszel
Fig. 9
Fig. 9
a The standardized mean difference (SMD) estimate for preoperative L1-S1 sagittal vertical axis (SVA)in 2 groups. b The standardized mean difference (SMD) estimate for post-operative L1-S1SVA in 2 groups. CI = confidence interval, df = degrees of freedom, M-H = Mantel–Haenszel
Fig. 10
Fig. 10
a The standardized mean difference (SMD) estimate for preoperative pelvic tilt (PT)in 2 groups. b The standardized mean difference (SMD) estimate for post-operative PT in 2 groups. CI = confidence interval, df = degrees of freedom, M-H = Mantel–Haenszel
Fig. 11
Fig. 11
a The standardized mean difference (SMD) estimate for preoperative sacral slope (SS) in 2 groups. b The standardized mean difference (SMD) estimate for post-operative SS in 2 groups. CI = confidence interval, df = degrees of freedom, M-H = Mantel–Haenszel
Fig. 12
Fig. 12
a The standardized mean difference (SMD) estimate for preoperative pelvic incidence (PI) in 2 groups. b The standardized mean difference (SMD) estimate for post-operative PI in 2 groups. CI = confidence interval, df = degrees of freedom, M-H = Mantel–Haenszel
Fig. 13
Fig. 13
a The standardized mean difference (SMD) estimate for preoperative lumbar lordosis (LL) in 2 groups. b The standardized mean difference (SMD) estimate for post-operative LL in 2 groups. CI = confidence interval, df = degrees of freedom, M-H = Mantel–Haenszel

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