Pre-Existing Adjacent Level Degeneration Effect On Decision Making In Single Level Lumbar Spondylolisthesis

Abstract

Background: Spondylolisthesis is common in white people rather than black and in male rather than
females due to fatigue and activities in extensions while degenerative type is more common in females
due to small posterior segment that become more liable for shear force. The aim of this work is to
examine the operative treatment outcome and then the need for second surgery between single level
fusion (the displaced level only) and multiple level fusions for (the displaced level and the adjacent
diseased level). Patients and methods: This cohort study is conducted at neurosurgery department,
Kasr Al-aini, Cairo University on 40 patients complaining from single level spondylolisthesis to
compare operative outcome between fusions of single level versus multiple level fusion. Patients are
random divided into two groups; group (A): who underwent concomitant fixation of the adjacent
degenerated level (6 screws). Group (B): who underwent fixation of single displaced level only (4
screws). All patients were treated operatively by posterior pedicle screw fixation either of single level
or multi level. All data was analyzed to evaluate whether concomitant fusion of the adjacent level
improve outcome and reduce the need for second surgery. Results: in group (A) 2 levels fixation the
age was 6 patients (30 %) from 40 – 50 years, 12 patients (60 %) from 51 – 60 years and 2 patients (10
%) above 60 years.In group (B) single level fixation the age was 8 patients (40 %) from 40 – 50
years,10 patients (50 %) from 51 – 60 years and 2 patients (10 %) above 60 years. In group (A) there
are 5 (25 %) males and 15 (75 %) females and in group (B) there are 6 (30 %) males and 14 (70 %)
females. In group (A) there are 7 patients (35 %) with ithmic type spondylolithesis and 13 patients (65
%) degenerative type. Group (B) there are 6 patients (30 %) with ithmic type spondylolithesis and 14
patients (70 %) degenerative type.. The degeneration in adjacent segments according to pfirmann's
grading system in MRI was as following: in group (A) with 2 levels fixation: there was 12 patients
(60%) grade II, 6 patients (30%) grade III and 2 patients (10%) grade IVIn group (B) with single level
fixation: there was 6 patients (30%) grade II, 7 patients (35%) grade III and 6 patients (30 %) grade IV
while one patient (5%) was grade V. Conclusion: Lumbar spine fusion should be done in the best
sagittal alignments, pfirmann's grading of disc degeneration is better to be evaluated for the adjacent
segments pre operative in case with lumbar spondylolisthesis with adjacent segment disease which
favour to include the adjacent segment in fusion if stage 3 or more was found.