Isthmic Spondylolisthesis is Associated with Less Revisions for Adjacent Segment Disease After Lumbar Spine Fusion Than Degenerative Spinal Conditions : A 10-Year Follow-Up Study

Study Design. Prospective, follow-up study. Objective. We aim to compare the rate of revisions for ASD after LSF surgery between patients with IS and DLSD. Summary of Background Data. ASD is a major reason for late reoperations after LSF surgery. Several risk factors are linked to the progression of ASD, but the understanding of the underlying mechanisms is imperfect. If IS infrequently becomes complicated with ASD, it would emphasize the role of the ongoing degenerative process in spine in the development of ASD. Methods. 365 consecutive patients that underwent elective LSF surgery were followed up for an average of 9.7years. Surgical indications were classified into 1) IS (n=64), 2) DLSD (spinal stenosis with or without spondylolisthesis) (n=222), and 3) other reasons (deformities, postoperative conditions after decompression surgery, posttraumatic conditions) (n=79). All spinal reoperations were collected from hospital records. Rates of revisions for ASD were determined using Kaplan-Meier methods. Results. Altogether, 65 (17.8%) patients were reoperated for ASD. The incidences of revisions for ASD in subgroups were 1) 4.8% (95% CI: 1.6%-22.1%); 2) 20.5% (95% CI: 15.6%-26.7%); 3) 20.6% (95% CI: 12.9%-31.9%). After adjusting the groups by age, sex, fusion length, and the level of the caudal end of fusion, when comparing with IS group, the other groups had significantly higher hazard ratios (HR) for the revision for ASD [2) HR (95% CI) 3.92 (1.10-13.96), P=0.035], [3) HR (95% CI) of 4.27 (1.11-15.54), P=0.036]. Conclusion. Among patients with IS, the incidence of revisions for ASD was less than a 4th of that with DLSD. Efforts to prevent the acceleration of the degenerative process at the adjacent level of fusion are most important with DLSD.publishedVersionPeer reviewe

Gorham–Stout disease with life-threatening pleural effusion treated with a pleuro-peritoneal shunt : a case report

Gorham–Stout disease (GSD) is a rare bone disease characterized by massive osteolysis and lymphatic proliferation. The origin of the condition is unknown, and no established treatment protocol exists. Massive pleural effusion is a frequent complication of GSD in the thoracic region. We present the case of a 23-year-old male with thoracic GSD, subsequent paraparesis, and life-threatening pleural effusion. The patient was managed by a multidisciplinary team with a good recovery. The pleural effusion was successfully treated with a pleuro-peritoneal shunt. This is the first report of the use of this mini-invasive technique in the management of pleural effusion related to GSD. Further, we present the potential role of interleukin-6 and bone resorption markers in the measurement of the disease activity.publishedVersionPeer reviewe

Isthmic Spondylolisthesis is Associated With Less Revisions for Adjacent Segment Disease After Lumbar Spine Fusion Than Degenerative Spinal Conditions : A 10-Year Follow-Up Study

Objective: We aim to compare the rate of revisions for adjacent segment disease (ASD) after lumbar spine fusion (LSF) surgery between patients with isthmic spondylolisthesis (IS) and degenerative lumbar spine disorders (DLSD). Summary of Background Data: ASD is a major reason for late reoperations after LSF surgery. Several risk factors are linked to the progression of ASD, but the understanding of the underlying mechanisms is imperfect. If IS infrequently becomes complicated with ASD, it would emphasize the role of the ongoing degenerative process in spine in the development of ASD. Methods: 365 consecutive patients that underwent elective LSF surgery were followed up for an average of 9.7 years. Surgical indications were classified into 1) IS (n=64), 2) DLSD (spinal stenosis with or without spondylolisthesis) (n=222), and 3) other reasons (deformities, postoperative conditions after decompression surgery, posttraumatic conditions) (n=79). All spinal reoperations were collected from hospital records. Rates of revisions for ASD were determined using Kaplan-Meier methods. Results: Altogether, 65 (17.8%) patients were reoperated for ASD. The incidences of revisions for ASD in subgroups were 1) 4.8% (95% CI: 1.6 to 22.1%); 2) 20.5% (95% CI: 15.6 to 26.7%); 3) 20.6% (95% CI: 12.9 to 31.9%). After adjusting the groups by age, sex, fusion length, and the level of the caudal end of fusion, when comparing with IS group, the other groups had significantly higher hazard ratios (HR) for the revision for ASD [2) HR (95% CI) 3.92 (1.10 to 13.96), p=0.035], [3) HR (95% CI) of 4.27 (1.11 to 15.54), p=0.036]. Conclusions: Among patients with IS, the incidence of revisions for ASD was less than a 4th of that with DLSD. Efforts to prevent the acceleration of the degenerative process at the adjacent level of fusion are most important with DLSD.peerReviewe

Postoperative Sagittal Balance has Only a Limited Role in the Development of Adjacent Segment Disease after Lumbar Spine Fusion for Degenerative Lumbar Spine Disorders : A Subanalysis of the 10-year Follow-up Study

Study Design. Retrospective Additional Analysis of a Prospective Follow-up Study. Objectives. We aimed to find out whether poor postoperative sagittal alignment increases revisions for adjacent segment disease (ASD) after lumbar spine fusion (LSF) performed for degenerative lumbar spine disease (DLSD). Summary of Background Data. Revisions for ASD accumulate over time after LSF for DLSD. The etiology of ASD is considered multifactorial. Yet, the role of postoperative sagittal balance in this process remains controversial. Methods. 215 consecutive patients who had undergone an elective LSF surgery for spinal stenosis with (80%) or without (20%) spondylolisthesis were analyzed. Spinal reoperations were collected from the hospital records. Pre- and postoperative sagittal alignment were evaluated from standing radiographs. The risk of revisions for ASD was evaluated by Cox proportional hazards regression models. Results. We did not find the poor postoperative balance (pelvic incidence – lumbar lordosis > 9°) to significantly increase the risk of revisions for ASD: crude hazard ratio (HR) 1.5 (95% CI 0.8–2.7), adjusted (by age, sex, pelvic incidence, fusion length, and the level of the caudal end of fusion) HR 1.7 (95% CI 0.9–3.3). We found higher lumbar lordosis outside the fusion segment (LL – segmental lordosis) to decrease the risk of revisions for ASD: HR 0.9 (95% CI 0.9–1.0). Conclusion. Poor sagittal balance has only a limited role as a risk factor for the revisions for ASD among patients with degenerative spinal disease. However, the risk for ASD might be the greatest among patients with reduced spinal mobility. Level of Evidence. 3peerReviewe