Treatment and Prevention of Adjacent-Level Syndrome in Degenerative Diseases of Lumbosacral Spine

F.I. Amin, Kh.I. Mershed, G.M. Kavalersky, A.D. Chensky, M.V. Boev, A.V. Baskov, S.V. Zhelvakov, O.N. Uchurov, I.Yu. Lisitsky, E.T. Beloborodov

(Faculty of Traumatology, Orthopedics and Surgery of Catastrophes, Sechenov Moscow Medical Academy, Municipal Clinical Hospital N 19, Moscow)

The Study Goal: To develop tactics of surgical management and prevention of adjacent-level syndrome in degenerative diseases of lumbosacral spine with applying dynamic implants, permitting to improve treatment results and life quality of patients.

Materials and Methods. We analyzed 30 cases, who had been operated for degenerative diseases of lumbosacral spine with transpedicular stabilization of affected segments. Degeneration of an adjacent segment, located above a stabilization level, was revealed in 15% of cases. Main clinical manifestations were represented by persistent pain in the spine. Two cases were operated with the purpose of unloading an adjacent segment and its dynamic stabilization. Repeated operations led to regression of pain syndrome.

Taking into account a positive experience of interventions for degeneration of an adjacent segment, we decided to operate 4 cases (2 males and 2 females) with marked spondylarthrosis of lumbosacral spine and to perform simultaneous transpedicular stabilization of affected segments with placing a dynamic fixing device at the upper adjacent level for prevention of syndrome under discussion. Indications for an operation included stenosis of a vertebral canal at two and more levels with roots compression due to discal hernias and hypertrophy of the yellow ligament with presence of spondylolysthesis and different-degree instability. Clinical manifestations were represented by radiculopathy, marked pain vertebrogenic and radicular syndrome and intermittent neurogenic claudication, watched in some cases.

Flavotomy and dynamic stabilization with an interspinal system were performed on an adjacent segment, located above the level of transpedicular fixation. There are two interspinal systems of dynamic stabilization, available in Russia: COFLEX (Paradigm Spine) and DIAM (Medtronic Sofamor Danek). Each of them was used twice in a group of 4 operated cases.

Results. We estimated neurological status dynamics, pain syndrome intensity (the visual-analog scale with a score from 1 to 10) and severity of functional activity disorders (Oswestry disability index - ODI). Postoperative regression of pain syndrome and neurological symptoms was observed in all six cases. Mean values of ODI reduced up to the level, indicative of minor disorders. A maximum period of follow-up by the time of this report was 6 months. The operated cases were subjected to regular control clinical and X-ray examinations. They revealed no negative dynamics. We are going to continue their follow-up and performing operations in compliance with the scheme, described above.

Conclusion. Thus, dynamic stabilization of an adjacent segment with the purpose of its unloading and a combination of this method with rigid stabilization of the spine in the abovementioned degenerative diseases allow to prevent development of adjacent-level syndrome and to ensure good clinical results.