Incidence and Risk Factors for Adjacent Segment Disease After Transforaminal Lumbar Interbody Fusion in Patients with Lumbar Degenerative Diseases

Jiawen Ye, Sizhen Yang, Zihan Wei, Chenhui Cai, Ying Zhang, Hao Qiu, Tongwei Chu Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Tongwei ChuDepartment of Orthopedics, Xinqiao Hospital, Army Medical University, Shapingba District, Chongqing, People’s Republic of ChinaTel +86 13708388336Email chtw@sina.comPurpose: To explore the incidence and risk factors for adjacent segment disease (ASD) in patients with lumbar degenerative diseases after transforaminal lumbar interbody fusion (TLIF).Patients and Methods: The clinical data of 1258 patients who underwent transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative diseases in our hospital from January 2011 to December 2017 were retrospectively analyzed. Patients were divided into the ASD group and non-ASD (N-ASD) group, and the incidence of ASD was calculated. We compared age, BMI, comorbidities, surgery-related parameters, and imaging parameters before surgery between the two groups and used univariate analysis and logistic regression analysis to explore the risk factors for ASD.Results: Among the 1258 patients who underwent TLIF due to lumbar degenerative diseases, 65 patients developed ASD and received surgical treatment for it, for an incidence of 5.2%. The average onset time of ASD was 68.3± 25.1 (20– 123) months. Univariate analysis showed that BMI, hypertension, preoperative adjacent segment disc degeneration and preoperative adjacent intervertebral disc height were significantly different between the ASD and N-ASD groups (P< 0.05). Incorporating the above indicators into the logistic regression model, the results showed that BMI and preoperative adjacent intervertebral disc degeneration were risk factors for ASD after TLIF.Conclusion: The incidence of ASD after TLIF in patients with lumbar degenerative disease is approximately 5.2%. High BMI and preoperative adjacent segment disc degeneration are risk factors for ASD after TLIF.Keywords: lumbar degenerative disease, transforaminal lumbar interbody fusion, adjacent segment disease, risk factors