Abstract
Although recent data suggests that lumbar fusion with decompression contributes to
some marginal acceleration of adjacent segment degeneration (ASD), few studies have
evaluated whether it is safe to perform a laminectomy above a fused segment. This
study investigates the hypothesis that laminectomy above a fused lumbar segment does
not increase the incidence of ASD, and assesses the benefits and risks of performing
a laminectomy above a lumbar fusion. A retrospective review of 171 patients who underwent
decompression and instrumented fusion of the lumbar spine was performed to analyze
the association between ASD and laminectomy above the fused lumbar segment. Patients
were divided into two groups – one group with instrumented fusion alone and the other
group with instrumented fusion plus laminectomy above the fused segment. Of the 171
patients, 34 underwent additional decompressive laminectomy above the fused segment.
There was a significant increase in ASD incidence as well as progression of ASD grade
in both groups. There was no significant increase in ASD in patients with decompressive
laminectomy above the fused lumbar segment compared to patients with laminectomy limited
to the fused segment. This retrospective review of 171 patients who underwent decompression
and instrumented fusion with follow-up radiographs demonstrates that laminectomy decompression
above a fused segment does not significantly increase radiographic ASD. There is,
however, a significant increase in ASD over time, which was observed throughout the
entire cohort likely representing a natural progression of lumbar spondylosis above
the fusion segment.
Keywords
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Article info
Publication history
Accepted:
February 23,
2013
Received:
January 8,
2013
Identification
Copyright
© 2013 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
