The Official journal of the China Association of Rehabilitation of Disabled Persons and the 88th Hospital of PLA

Composite Impact Factor:

0. 948 (2015)

Total citation frequency: 3868 (2015)

ISSN 1005-8478

CN 37-1247/R

A retrospective study on adjacent segment degeneration secondary to L4-5 fusion

Author : CAO Hua, CHEN Bu-jun, QI Wei, etal.     
Working unit : Departmentof Spine and Joint Surgery, The 359th Hospital of PLA, Zhenjiang 212000,China
Page : 1954-1957
Key words : adjacentsegment degeneration ASD, lumbar fusion, reoperation



To determine the incidence and the risk factors of adjacent segment degenerationASDafter

L4-5 fusion with posterior lumbar interbody fusion PLIFor transforaminal lumbar interbody fusion TLIF.


We retrospectively reviewed medical records of all the patients who underwent the L4-5 fusion by PLIF or TLIF for degenerative spinal disease and followed up more than1year in the past ten years in our hospital. ASD was defined as clinical and/or radiographic evidence of degenerative spinal disease that required reoperation at the adjacent discs above or below L4-5 level.


Of the 355 patients who underwent spinal fusion at the L4-5 level, the ASD occurred in 42 patients54 segmentsincluding 3 patients at L1-2 5%, 13 at L2-3 24%, 29 at L3-4 54%and 9 at L5S1 17%, associated with a total incidence of 11.8%. In term of involved segment, the L34 was the most susceptible levelP<0.001. Although The incidences of ASD in the PLIF was higher than the TLIF, there was not statistical difference between them 14% versus 9.5%, P=0.189. The cephalic ASD was statistically more common than the caudal ASD in both the PLIF P<0.001and TLIFP<0.001. The average elapsed time to ASD was 2 years after L4-5 fusion, however, no a statistical difference was noted between the PLIF and TLIF in time of ASD happened based on a Kaplan-Meier analysis P=0.1559.


The cumulative incidence of ASD requiring reoperation is 12% over a mean period of 2 years with the most susceptible level at the L3-4. Both the  PLIF and TLIF have similar incidences of ASD.

A retrospective study on adjacent segment degeneration secondary to L4-5 fusion   
CAO Hua, CHEN Bu-jun, QI Wei, etal.
Orthop J Chin,2017,25(21):   1954-1957