[Effect of adjacent segmental facet joint degeneration on adjacent segment disease after lumbar fusion and fixation].

OBJECTIVE

To explore the effect of facet joint degeneration in adjacent segments on the incidence of adjacent segment disease (ASD) after lumbar fusion and fixation.

METHODS

A retrospective analysis was performed on 138 patients who underwent LS posterior lumbar interbody fusion (PLIF) from June 2016 to June 2019. Patients were divided into a degeneration group (68 cases) and a non-degenerative group (70 cases) based on the presence or absence of L facet joint degeneration before surgery (graded using the Weishaupt standard). Age, gender, body mass index (BMI), follow-up time, and preoperative L intervertebral disc degeneration (graded using the Pfirrmann standard) were collected for both groups. Clinical outcomes were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) at 1 and 3 months after surgery. The incidence and time of ASD after surgery were analyzed.

RESULTS

There were no significant differences between the two groups in age, gender, BMI, follow-up time, or preoperative L intervertebral disc degeneration. Both groups showed significant improvement in VAS and ODI at 1 and 3 months after surgery (<0.001), with no significant difference between the groups(>0.05). However, there was a statistically significant difference in the incidence and timing of ASD between the groups (<0.05). The degeneration group had 2 cases of ASD in gradeⅠdegeneration, 4 cases of ASD in gradeⅡdegeneration, and 7 cases of ASD in grade Ⅲ degeneration. There was a statistically significant difference between the number of patients with grade Ⅲ degeneration and those with gradesⅠandⅡASD (<0.0167, Bonferroni correction).

CONCLUSION

Preoperative degeneration of adjacent articular processes will increase the risk of ASD after lumbar fusion fixation, whereas gradeⅢ degeneration will further increase the risk.