Operative Treatment of the Degenerated Segment Adjacent to a Lumbar Fusion

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Abstract
Fourteen patients with a previous lumbosacral fusion underwent neural decompression and fusion of a degenerated adjacent motion segment. The most common level was L3–L4, and there was an average of 3.2 (range 1–7) previous lumbosacral surgical procedures. The average interval from the first fusion until operative intervention on the degenerated adjacent segment was 11.5 years (range 3–29 years). Five patients had an uninstrumented fusion, of which only one progressed to arthrodesis. Three of these five patients with pseudarthrodsis after uninstrumented fusion—and the remaining nine patients—had fusions with instrumentation. Ten of twelve instrumented fusions progressed to solid arthrodesis. The pseudarthrosis rate of 80% was decreased to 17% with the use of supplemental instrumentation. There was a significant number of complications and poor results, especially in patients with advanced osteoporosis and those with a short interval between adjacent segment degeneration, respectively. Eleven of 14 patients reported some postoperative pain relief.

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