Long-term clinical outcomes and development of degenerative diseases of the adjacent proximal segment during personalized lumbar transforaminal fusion: A multicenter prospective study

Abstract

Long-term clinical outcomes and incidence of degenerative diseases of the adjacent proximal segment during personalized lumbar transforaminal fusion were prospectively assessed. According to the created register, the observational prospective multicenter study included 209 patients who underwent primary open transforaminal lumbar fusion according to generally accepted indications at the LIV–SI vertebral level between 2015 and 2019, and in these patients, adjacent vertebral motion segment had initial degeneration of the adjacent segment in varying severity levels. The risk of developing degenerative adjacent segment disease on the proximal spinal motion segment was assessed using an original method (Patent 2762496 of the Russian Federation, December 21, 2021, Bulletin No. 36). The surgical technique in relation to the adjacent spinal motion segment was determined according to the algorithm for personalized implementation of open transforaminal lumbar fusion. Instrumental parameters were studied in the preoperative period, and development of degenerative adjacent segment disease in the long-term postoperative follow-up was examined at 65 (60–74) months. After a comprehensive assessment of the risk of developing a degenerative adjacent segment disease, monosegmental open transforaminal lumbar fusion was performed in 75 patients, open transforaminal lumbar fusion with interspinous stabilization of the adjacent vertebral motion segment in 69, and involvement of the adjacent vertebral motion segment in rigid stabilization in 65. The incidence of degenerative adjacent segment disease was 4.9% (n = 10). Thus, a comprehensive assessment of the risk of developing degenerative adjacent segment disease and a personalized algorithmic approach to performing open transforaminal lumbar fusion can significantly improve long-term clinical results and reduce the incidence of this degenerative disease in a minimum 5-year follow-up period.