Disruption of the posterior ligamentous complex at the rostral segment of lumbar fusion leads to higher revision rates in short term. A single center, retrospective study.

Abstract

Abstract Purpose: The development of symptomatic adjacent segment disease (sASD) following posterior lumbar decompression and fusion (PLDF) contributes to patients' post-operative morbidity in the form of recurrent back pain and radiculopathy and often requires further surgery[1]. One hypothesized risk factor for ASD is the posterior ligamentous complex (PLC) integrity between the upper instrumented vertebra (UIV) and the first unfused segment (UIV+1)[2]. The purpose of this study is to determine and quantify the radiographic and clinical role of preserving the PLC between the UIV and the UIV+1 in preventing sASD. Methods: A retrospective review of 122 patients who received a PLDF was performed. Patients were divided into groups based on the integrity of the PLC between the UIV and the UIV+1: PLC disrupted (D) and PLC intact (I). Development of ASD was assessed by standard radiographic parameters and a review of reoperation rates for ASD. Results: The revision rate due to sASD of the entire cohort was 7.4%. Revision rate of group-D (28 patients) exceeded the revision rate of group-I (94 patients) by 4.3% (10.7 vs. 6.4%), over a mean follow-up of three years. The mean return to the OR -time due to sASD at the UIV+1 was 2.4 years (± 1.7 y.) after index surgery. All applied radiographic indicators for ASD suggested higher incidences in patients of group-D, without statistical significance. Conclusions: When the pathology allows, care should be taken to preserve the PLC during lumbar decompression and fusion surgery at the rostral aspect of the construct. Trial registration: The study was approved by our institutional review board (STUDY2021000355).