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العنوان
Adjacent segment disease after short segment lumbar fixation /
المؤلف
Ibrahim, Thabet Ibrahim Thabet.
هيئة الاعداد
باحث / ثابت إبراهيم ثابت إبراهيم
مناقش / أحمد يحى مصطفى
مناقش / هشام عادل أبو العنين
مشرف / ياسر محمود البنا
الموضوع
Surgery.
تاريخ النشر
2016.
عدد الصفحات
73 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
جراحة
تاريخ الإجازة
1/9/2016
مكان الإجازة
جامعة الاسكندريه - كلية الطب - Surgery
الفهرس
Only 14 pages are availabe for public view

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from 87

Abstract

The term “adjacent segment degeneration” is used to describe radiographic changes seen at levels adjacent to a previous spinal fusion procedure.
On the other hand, the term “adjacent segment disease” is used to refer to the development of new clinical symptoms that correspond to radiographic changes adjacent to the level of a previous spinal fusion as stenosis or Spondylolisthesis.
The exact mechanism remains uncertain, altered biomechanical stresses appear to play a key role in the development of adjacent segment disease.
The diagnosis of symptomatic adjacent segment disease was based on both newly developed clinical symptoms and radiological lesions. The clinical symptoms referable to the adjacent levels were defined as low back pain and/or radiculopathy. Plain radiographs, CT and MRI were used for the radiological evaluation.
The aim of our study was to determine the incidence, risk factors and treatment of ASD among patients previously treated with short segment lumbar fixation. To compare the survivorship of adjacent segment according to various risk factors.
This retrospective study conducted on fifty patients operated for short segment lumbar fixation for one to two motion segment maximum using transpedicular fixation either top or side loading system using either plates or rods with bony fusion either interbody or postlateral. All patients were presented to department of Neurosurgery in Gamal Abd ElNaser Hospital.
All patients were subjected to: complete history taking which included the following symptoms: Back pain, Neurogenic Claudication, Sciatica, motor deficit and sphincteric disturbance, Full neurological examination, Routine laboratory investigations, Plain X-ray of lumbosacral spine, Magnetic resonance imaging (MRI) for all patients and CT of the lumbosacral spine.
The results obtained from this study showed that this study was done on 50 patients operated for short segment lumbar fixation, 11(22%) of the patients had ASD. The age ranged from 40 to 59 with the mean of 53.64 years. 4(36.4%) patients were male and 7(63.6%) patients were female. 3(27.3%) patients had disc degeneration, 7(63.6%) patients had degenerative Spondylolisthesis and 1(9.1%) patient had retrolisthesis. 7(63.6%) patients were smokers and 4(36.4%) patients were non-smokers, 2 patients had DM and one patient was on steroid therapy. single level fusion was performed in 5 patients and two-level fusion in 6 patients. Cranial segment affection was reported in 7 patients, caudal segment affection in 3 patients and cranial and caudal segment affection in one patient. 9 patients were operated upon for spondylolisthesis while 2 patients were operated upon for degenerated discs disease. All patients were operated upon using the rigid pedicle screw fixation, 4(36.4%) patients with PLF and 7(63.6%) patients with PLIF. Duration of the lucid interval between the primary surgery and the presentation ranged from 36 to 59 months with mean 49.86±5.107months. 7 patients were managed successfully conservatively and were followed up for at least 6 months with acceptable improvement in their clinical conditions. 4 patients were in need for decompressive laminectomy and with or without extension of the instrumentation to the affected segment. Those revised patients were as follow; one of these patients treated for degenerated disc prolapse leading to moderate to severe canal stenosis, and the other three patients were treated for degenerative spondylolisthesis leading to canal stenosis and roots compression and /or stretch.
There was statistically significant differences between patients had ASD (positive group) and patients didn`t had ASD (negative group) regarding the number of fused segment were in the negative ASD group 33(84.6%) patients had Single-level fusion and 6(15.4%) patients had two-level fusion while in positive ASD group 5(45.5%) patients had Single-level fusion and 6(54.5%) patients had two-level fusion. where p= 0.014.
Also, There was statistically significant differences between patients had ASD (positive group) and patients didn`t had ASD (negative group) regarding the BMI were in the negative ASD group ranged between 24 – 32 with mean ±S.D. 28.56±2.245 while in positive ASD group ranged between 30 – 38 with mean ±S.D. 33.73±2.76, where P=0.000, and there was a statistically significant difference between the negative and positive ASD group as regard to the pre-existing degeneration, in the positive ASD group 2(18.2%) patients had disc degenerative, 8 (72.7%) patients had degenerative facet and one (9.1%) patient was normal adjacent segment while in the negative ASD group all 39(100%) patients were normal adjacent segment, where P=0.000.
Also, There was statistically significant differences between patients had ASD (positive group) and patients didn`t had ASD (negative group) regarding the laminar inclination angle at the cranial vertebra adjacent to the fused level, in negative ASD group the angle ranged between 122.3-130.7 degrees with mean ±S.D 127.0±4.7 degrees while in the positive ASD group the angle ranged between 131.4-138.2 degrees with mean ±S.D. 134.8±3.4 degrees where (p< 0.01).