Advertisement
Advertisement

The Internet Journal of Minimally Invasive Spinal Technology ISSN: 1937-8254


Adjacent or Junctional Disc Herniations in Post Spinal Fusion Treated With Endoscopic Spinal Surgery for Segmental Motion Preservation

John C. Chiu D.Sc, M.D., FRCS Director, Neurospine Surgery, California Spine Institute Medical Center Thousand Oaks, CA USA
Citation:  J.C. Chiu: Adjacent or Junctional Disc Herniations in Post Spinal Fusion Treated With Endoscopic Spinal Surgery for Segmental Motion Preservation. The Internet Journal of Minimally Invasive Spinal Technology. 2007 Volume 1 Number 1

Abstract

Introduction: Fusions of the cervical and lumbar spine are often followed within months or several years by protrusion of discs at the adjacent level or levels. Mobility lost at the fused levels is thought to be transferred to the adjacent segment/s increasing stress on the disc, resulting in early recurrent protrusion at that level. In a number of anterior cervical fusions (ACF) and lumbar fusions this occurs in both superior and inferior adjacent levels simultaneously. Materials and Methods: Case reports 180 of post spinal fusion junctional disc herniations (260) (also called transitional discs, or adjacent segment failure) are reported, as well as a review of the literature to determine their frequency of occurrence following fusions of the lumbar and cervical spine. Results: Average time to return to work was 14 days. At an average follow-up of 18 months. For single level, 92% had good to excellent symptomatic relief and spinal motion preservation. There were no intraoperative complications. 8% of patients had partial or no pain relief after surgery. Cervical and lumbar endoscopic minimally invasive spinal surgery (MISS) combined with laser thermodiskoplasty, is an ideal way to treat junctional discs to avoid a sequential recurrence. Treating protruded cervical and lumbar discs with MISS as the initial procedure of choice would avoid destabilizing adjacent segments, largely prevent post spinal fusion junctional disc syndrome and preserve spinal segmental motion. Conclusion: MISS provides the optimal method to treat post spinal fusion junctional disc syndrome of the cervical and lumbar spine with minimal morbidity, and no threat of further junctional recurrence and at less cost. Its use as the initial treatment of choice would greatly lessen the incidence of this syndrome and preserve spinal segmental motion.

References

1. Chiu JC, Clifford TC, Shaw, S, et al. Junctional disc herniation syndrome following spine fusion treated by minimally invasive spinal surgery. J Min Inv Spinal Tech 2003;3:57-61.
2. Chiu JC, Clifford TC, Shaw S, et al. Junctional disc herniation syndrome following cervical fusion: report of four cases treated by endoscopic laser surgery. J Min Inv Spinal Tech 2004;4:53-5.
3. Cochran T, Irstam L, Nachamson A. Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated by Harrington rod fusion. Spine 1983;8:576-84.
4. Brodsky AE. Post-laminectomy and post-fusion stenosis of the lumbar spine. Clin Orthrop 1976;115:130-9.
5. Frymoyer JW, Hanley E, Howe J, et al. Disc excision and spine fusion in the management of lumbar disc disease. A minimum ten year followup. Spine 1978;3:1-6.
6. Hambly MF, Wiltse LL, Raghavan N, et al. The transition zone above a Lumbosacral fusion. Spine 1998;23:1785-92.
7. Ghiselli G, Wang JC, Hsu WK, et al. L5-S1 segment survivorship and clinical outcome analysis after L4-L5 isolated fusion. Spine 2003;28:1275-80.
8. Ghisselli G, Wang JC, Bhatia N, et al. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am 2004;86-A(7):1497-503.
9. Lehmann TR, Spratt KF, Tozzi JE, et al. Long-term follow-up of lower lumbar fusion patients. Spine 1987;12:97-104.
10. Lee CK. Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine 1988;13:375-7.
11. Leong JC, Chun SY, Grange WJ, et al. Long-term results of lumbar intervertebral disc prolapse. Spine 1983;8:793-9.
12. Miyakoshi N, Abe E, Shimada Y, et al. Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. Spine 2000;25:1837-42.
13. Penta M, Sandu A, Fraser RD. Magnetic resonance imaging assessment of disc degeneration 10 years after anterior lumbar interbody fusion. Spine 1995;20:743-7.
14. Pihiajamakl H, Bostman O, Ruuskanon M, et al. Posterolateral lumbosacral fusion with transpedicular fixation: 63 consecutive cases followed for 4 (2-5) years. Acta Orthop Scand 1996;67:63-8.
15. Schlegel JD, Smith JA, Schleuser RL. Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. Spine 1996;21:970-81.
16. Whitecloud TS 3rd, Davis JM, Olive PM. Operative treatment of the degenerated segment adjacent to a lumbar fusion. Spine 1994;19:531-5.
17. Yang SW, Langrana NA, Lee CK. Biomechanics of lumbosacral spinal fusion in combined compression-torsion loads. Spine 1986;11:937-41.
18. Lee CK, Langrana NA. Lumbosacral spinal fusion. A biomechanical study. Spine 1984;9:574-81.
19. Quinnell RC, Stockdale HR. Some experimental observations of the influence of a single lumbar floating fusion on the remaining lumbar spine. Spine 1981;6:263-7.
20. Boden SD, Davis DO, Dina TS, et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990;72:403-8.
21. Hillbrand AS, Carlson GD, Palumbo MA, et al. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999;81:519-28.
22. Pope MH, Wilder DG, Marreri RE, et al. Experimental measurements of vertebral motion under load. Orthop Clin North Am 1977;8:158-7.
23. Park P, Garton, Gala V, et al. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 2004;29(17):1938-44.
24. Chiu J, Clifford T, Princenthal R, Junctional Disc Herniation in Post Spinal Fusion Treated with Endoscopic Spine Surgery: In, Szabo Z, Coburg AJ, Savalgi R, Reich H, Yamamotto M, eds. Surgical Technology International XIV, UMP, San Francisco, CA 2005: p.305-315
25. Chiu J. Endoscopic lumbar foraminoplasty. In: Kim D, Fessler R, Regan J (eds), Endoscopic spine surgery and instrumentation. New York: Thieme Medical Publisher; pp 212-29, 2004.
26. Chiu J. Digital technology assisted minimally invasive spinal surgery (MISS) for spinal motion preservation. In: Lemke HU, Vannier MN, Invamura RD (eds), Computer assisted radiology and surgery. Amsterdam, San Diego, Oxford, London: Elsevier Medical Publisher; pp 461-6, 2004.
27. Chiu J, Clifford T, Greenspan M. Percutaneous microdecompressive endoscopic cervical discectomy with laser thermodiskoplasty. Mt Sinai J Med 2000;67:278-82.
28. Chiu JC, Clifford TJ, Negron F, et al. Microdecompressive percutaneous discectomy: spinal discectomy with new laser thermodiskoplasty for non-extruded herniated nucleus pulposus. Surg Technol Int VIII; pp 343-51, 1999.
29. Chiu JC, Clifford TJ, Reuter MW. Cervical endoscopic discectomy with laser thermodiskoplasty, In: Savitz MH, Chiu JC, Yeung AT (eds), The practice of minimally invasive spinal technique. Richmond, VA, AAMISMS EDUCATION; pp 141-8, 2000.
30. Chiu J. Anterior endoscopic cervical microdiscectomy. In: Kim D, Fessler R, Regan J (eds), Endoscopic spine surgery and instrumentation. New York: Thieme Medical Publisher; pp 48-58, 2004.
31. Chiu J. Evolving transforaminal endoscopic microdecompression for herniated lumbar discs and spinal stenosis. Surg Technol Int XIII; pp 276-86, 2004.
32. Gertzbein SD, Hollopeter MR. Disc herniation after lumbar fusion. Spine 2002;27:373-6.
Generated at: Wed, 23 May 2012 02:09:01 -0500 (00000076) — http://www.ispub.com:80/journal/the-internet-journal-of-minimally-invasive-spinal-technology/volume-1-number-1/adjacent-or-junctional-disc-herniations-in-post-spinal-fusion-treated-with-endoscopic-spinal-surgery-for-segmental-motion-preservation.html