Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion.

Abstract

Adjacent segment disease (ASD) is an increasing problematic complication following lumbar fusion surgeries. ASD requires appropriate treatment, although there are only few reports on surgery for ASD. This study aimed to clarify surgical outcomes of posterior lumbar interbody fusion (PLIF) for ASD. Medical charts of 18 patients who underwent the second (repeat) PLIF for ASD were retrospectively investigated (average follow-up, 40 [27-66] months). Modified Japanese Orthopaedic Association (JOA) score and Whitecloud classification were used as outcome measures. Mean modified JOA score improved from 7.7 just before repeat PLIF to 11.4 at maximum recovery and declined to 10.2 at final follow-up. Mean recovery rate of modified JOA score was 52.9 % at maximum recovery and 31.6 % at final follow-up. According to Whitecloud classification, 17 patients (94 %) were excellent or good and only 1 was fair at maximum recovery, whereas 10 (56 %) were excellent or good, 6 were fair, and 2 were poor at final follow-up. Eight patients (44 %) deteriorated again because of recurrent ASD. Two poor patients underwent a third PLIF. PLIF is effective for ASD after PLIF in the short term, although it tends to lead to a high incidence of recurrent ASD.