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Eur Spine J. 2016 May;25(5):1550-1557. doi: 10.1007/s00586-016-4469-5. Epub 2016 Mar 8.

Adjacent segment degeneration and revision surgery after circumferential lumbar fusion: outcomes throughout 15 years of follow-up.

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Department of Orthopedic Surgery, University Clinic Hospital, Blasco Ibáñez 17, 46010, Valencia, Spain.
Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Quevedo 2, 46001, Valencia, Spain.
Department of Orthopedic Surgery, Hospital Universitario de la Ribera, Carretera Corbera, km 1, 46600, Alzira, Spain.



This retrospective study analyzes long-term outcomes (15 years) of circumferential lumbar fusion (CF) for degenerative spine disease using instrumented PLIF. The occurrence of adjacent segment degeneration (ASD) and the reintervention rate was specially focused.


A series of 73 patients who underwent CF (1-3 levels) was reviewed. Patients were evaluated preoperatively, at 2, 5, 10 and 15 years after surgery with static and dynamic radiographic studies, CT scan and MRI. Patients completed also the Oswestry-Disability index (ODI), the VAS score, and the patient self-satisfaction questionnaire.


At 2-year follow-up, there was a decrease in the average ODI score (from 72.3 ± 16.4 preop to 30.5 ± 6.2). At 10- and 15-year follow-up, ODI scores return to preoperative scores in patients without revision surgery. The 82.8 % of patients referred an excellentgood self-satisfaction rate at this time. At 5-year follow-up, seven patients (9.6 %) required reoperation because of symptomatic ASD. At 10-year follow-up, reoperated patients increased to 24.6 % (18 cases). Excellent and good self-satisfaction rate decreased to 41.1 % at this time. Radiological ASD was then detected in 37 cases (50.7 %). At 15-year follow-up, nine patients were lost and a total of 24 (37.5 %) required a new surgical treatment because of ASD. The occurrence of revision surgery because of symptomatic ASD was highly dependent of the age of patients at the first surgery and the number of fused levels.


Circumferential lumbar fusion provides good clinical results at short-term follow-up. From 2- to 15-year follow-up, outcome worsened significantly. The high rate of ASD occurrence and reintervention questions the reliability of this technique for lumbar fusion.


Adjacent segment degeneration; Circumferential lumbar fusion; Degenerative spine disease; Revision surgery

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