Incidence and risk factors of reoperation in patients with adjacent segment disease: A meta-analysis

STUDY DESIGN: This was a systematic review of the literature and meta-analysis. OBJECTIVE: The objective of this study was to evaluate the current literature regarding the risk factors contributing to reoperation due to adjacent segment disease (ASD). SUMMARY OF BACKGROUND DATA: ASD is a broad term referring to a variety of complications which might require reoperation. Revision spine surgery is known to be associated with poor clinical outcomes and high rate of complications. Unplanned reoperation has been suggested as a quality marker for the hospitals. MATERIALS AND METHODS: An electronic search was conducted using PubMed. A total of 2467 articles were reviewed. Of these, 55 studies met our inclusion criteria and included an aggregate of 1940 patients. Data were collected pertaining to risk factors including age, sex, fusion length, lumbar lordosis, body mass index, pelvic incidence, sacral slope, pelvis tilt, initial pathology, type of fusion procedure, floating versus sacral or pelvic fusion, presence of preoperative facet or disc degeneration at the junctional segment, and sagittal orientation of the facets at the junctional segment. Analysis of the data was performed using Comprehensive Meta-Analysis software (Biostat, Inc.). RESULTS: The overall pooled incidence rate of reoperation due to ASD from all included studies was 0.08 (confidence interval: 0.065–0.098). Meta-regression analysis demonstrated no significant interaction between age and reoperation rate (P = 0.48). A comparison of the event rates between males and females demonstrated no significant difference between male and female reoperation rates (P = 0.58). There was a significantly higher rate of ASD in patients with longer fusion constructs (P = 0.0001). CONCLUSIONS: We found that 8% of patients in our included studies required reoperation due to ASD. Our analysis also revealed that longer fusion constructs correlated with a higher rate of subsequent revision surgery. Therefore, the surgeon should limit the number of fusion levels if possible to reduce the risk of future reoperation due to ASD. LEVEL OF EVIDENCE: IV