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MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure

Background: Adjacent segment degeneration (ASD) has become a great concern as a late complication in patients following fusion spine surgery with a potential need for revision surgery. Segments above the fused spine have higher mobility and they are especially prone to accelerated disc degeneration....

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Autores principales: Dujic, Milka Kljaic, Recnik, Gregor, Milcic, Milko, Bosnjak, Eva, Rupreht, Mitja
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9321056/
https://www.ncbi.nlm.nih.gov/pubmed/35887716
http://dx.doi.org/10.3390/jcm11143952
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author Dujic, Milka Kljaic
Recnik, Gregor
Milcic, Milko
Bosnjak, Eva
Rupreht, Mitja
author_facet Dujic, Milka Kljaic
Recnik, Gregor
Milcic, Milko
Bosnjak, Eva
Rupreht, Mitja
author_sort Dujic, Milka Kljaic
collection PubMed
description Background: Adjacent segment degeneration (ASD) has become a great concern as a late complication in patients following fusion spine surgery with a potential need for revision surgery. Segments above the fused spine have higher mobility and they are especially prone to accelerated disc degeneration. The purpose of our study is to investigate early disc degenerative changes two levels above a surgically fused lumbar spine segment and to compare MRI analyses after unilateral and bilateral TLIF procedures. Methods: A total of 117 patients were included in this cross-sectional retrospective single center study (after bilateral TLIF surgery: n = 91, and after unilateral TLIF: n = 26). In both groups, the average patient age was similar: 62.84 years (SD = 12.53) in the unilateral TLIF group and 60.67 years (SD = 11.89) in the bilateral TLIF group. On average, MRI was performed 2.5 years after surgery (SD = 2.09). The modified eight-level Pfirrmann grading system was used for the assessment of disc degeneration severity. Descriptive statistics and the Mann–Whitney test were used to show differences in the Pfirrmann grades regarding the after-surgery period and the patient age. The Wilcoxon signed-rank test results were used to display differences in the Pfirrmann grades before and after surgery. Results: The comparison of mean values, regardless of the type of surgery, shows that this mean value is on average higher in the first segment adjacent to the fused spine segment. The assessment of the intervertebral disc structure in BIL TLIF is higher in both the first and the second segment. Early disc degeneration progression is subtle yet detectable (UNI TLIF 9.28% vs. BIL TLIF 16.74%). The assessment of the intervertebral disc structure is on average lower in patients aged less than 50 years at time of surgery compared with patients aged more than 50 years in UNI TLIF, and higher in the BIL TLIF group, for both the first and the second segment. Conclusion: Patients who had undergone unilateral TLIF fusion surgery have a lower rate of early disc degenerative changes. Considering a significantly higher rate of progressive disc degenerative changes in the elderly with bilateral fusion surgery, extra caution is required in the selection of appropriate surgical technique.
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spelling pubmed-93210562022-07-27 MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure Dujic, Milka Kljaic Recnik, Gregor Milcic, Milko Bosnjak, Eva Rupreht, Mitja J Clin Med Article Background: Adjacent segment degeneration (ASD) has become a great concern as a late complication in patients following fusion spine surgery with a potential need for revision surgery. Segments above the fused spine have higher mobility and they are especially prone to accelerated disc degeneration. The purpose of our study is to investigate early disc degenerative changes two levels above a surgically fused lumbar spine segment and to compare MRI analyses after unilateral and bilateral TLIF procedures. Methods: A total of 117 patients were included in this cross-sectional retrospective single center study (after bilateral TLIF surgery: n = 91, and after unilateral TLIF: n = 26). In both groups, the average patient age was similar: 62.84 years (SD = 12.53) in the unilateral TLIF group and 60.67 years (SD = 11.89) in the bilateral TLIF group. On average, MRI was performed 2.5 years after surgery (SD = 2.09). The modified eight-level Pfirrmann grading system was used for the assessment of disc degeneration severity. Descriptive statistics and the Mann–Whitney test were used to show differences in the Pfirrmann grades regarding the after-surgery period and the patient age. The Wilcoxon signed-rank test results were used to display differences in the Pfirrmann grades before and after surgery. Results: The comparison of mean values, regardless of the type of surgery, shows that this mean value is on average higher in the first segment adjacent to the fused spine segment. The assessment of the intervertebral disc structure in BIL TLIF is higher in both the first and the second segment. Early disc degeneration progression is subtle yet detectable (UNI TLIF 9.28% vs. BIL TLIF 16.74%). The assessment of the intervertebral disc structure is on average lower in patients aged less than 50 years at time of surgery compared with patients aged more than 50 years in UNI TLIF, and higher in the BIL TLIF group, for both the first and the second segment. Conclusion: Patients who had undergone unilateral TLIF fusion surgery have a lower rate of early disc degenerative changes. Considering a significantly higher rate of progressive disc degenerative changes in the elderly with bilateral fusion surgery, extra caution is required in the selection of appropriate surgical technique. MDPI 2022-07-07 /pmc/articles/PMC9321056/ /pubmed/35887716 http://dx.doi.org/10.3390/jcm11143952 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Dujic, Milka Kljaic
Recnik, Gregor
Milcic, Milko
Bosnjak, Eva
Rupreht, Mitja
MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure
title MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure
title_full MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure
title_fullStr MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure
title_full_unstemmed MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure
title_short MRI Assessment of the Early Disc Degeneration Two Levels above Fused Lumbar Spine Segment: A Comparison after Unilateral and Bilateral Transforaminal Lumbar Interbody Fusion (TLIF) Procedure
title_sort mri assessment of the early disc degeneration two levels above fused lumbar spine segment: a comparison after unilateral and bilateral transforaminal lumbar interbody fusion (tlif) procedure
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9321056/
https://www.ncbi.nlm.nih.gov/pubmed/35887716
http://dx.doi.org/10.3390/jcm11143952
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