Management of pain syndrome in patients with adjacent level pathology – long-term outcomes after minimally invasive technologies

Long-term outcomes (3–5 years) in 71 patient with the adjacent level lesion syndrome (ALDS) were analyzed. All patients underwent minimally invasive surgical interventions (puncture laser decompression of intervertebral discs and radiofrequency denervation of the facet joints) in the neurosurgical department of Irkutsk Scientific Center for Surgery and Traumatology. The applied technology was chosen after analyzing clinical examination findings, introscopy findings, degeneration coefficient and intervertebral disc height.

In the study, there were 37 males, 34 females. Average age 54.1 ± 2.3 years. The time interval between the initial decompression and stabilization surgery and the subsequent minimally invasive surgical intervention was 48 ± 3.8 months.

The effectiveness of minimally invasive surgical treatment was assessed after analyzing clinical and neurological findings, radiological findings (MRI, MSCT, overview and functional spondylography) as well as by the visual analog pain scale and MacNab questionnaire.

1. Масевнин С.В., Пташников Д.А., Михайлов Д.А., Смекаленков О.А., Заборовский Н.С., Лапаева О.А., Ян Л., Мураби З. Роль основных факторов риска в раннем развитии синдрома смежного уровня у пациентов после спондилодеза поясничного отдела позвоночника. Хирургия позвоночника. 2016; 13(3): 60–67. DOI: 10.14531/ ss2016.3.60-67

2. Chang S.Y., Chae I.S., Mok S., Park S.C., Chang B.S., Kim H. Can Indirect Decompression Reduce Adjacent Segment Degeneration and the Associated Reoperation Rate After Lumbar Interbody Fusion? A Systemic Review and Meta-analysis. World Neurosurg. 2021 Sep; 153:e435-e445. DOI: 10.1016/j.wneu.2021.06.134. Epub 2021 Jul 3. PMID: 34229099.

3. Животенко А.П., Потапов В.Э., Кошкарева З.В., Сороковиков В.А. Клинический случай хирургического лечения смежного сегмента позвоночника при спондилодезе. Acta biomedica scientifica. 2020; 5 (5): 53–59. DOI:10.29413/ABS.2020-5.5.7

4. Никитин А.С., Асратян С.А., Новиков А.Е. Синдром поражения смежного уровня поясничного отдела позвоночника после спондилодеза. Вестник ИвГМА. 2015; 2: 66–70.

5. Donnally C.J. 3rd, Patel P.D., Canseco J.A., Divi S.N., Goz V., Sherman M.B., Shenoy K., Markowitz M., Rihn J.A., Vaccaro A.R. Current incidence of adjacent segment pathology following lumbar fusion versus motion-preserving procedures: a systematic review and meta-analysis of recent projections. Spine J. 2020 Oct; 20(10): 1554–1565. DOI: 10.1016/j.spinee.2020.05.100. Epub 2020 May 20. PMID: 32445805.

6. Reid P.C., Morr S. & Kaiser M.G. State of the union: A review of lumbar fusion indications and techniques for degenerative spine disease. Journal of Neurosurgery: Spine. 2019; 31: 1–14.

7. Шнякин П.Г., Ботов А.В., Амельченко А.А. Хирургические методы лечения рецидива болевого синдрома при дегенеративной патологии поясничного отдела позвоночника. Анналы клинической и экспериментальной неврологии 2018; 12(3): 61–68. DOI: 10.25692/ACEN.2018.3.8

8. Sebaaly A., Lahoud M.J., Rizkallah M., Kreichati G., Kharrat K. Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome. Asian Spine J. 2018 Jun; 12(3): 574–585. DOI: 10.4184/asj.2018.12.3.574. Epub 2018 Jun 4. PMID: 29879788; PMCID: PMC6002183.

9. Fornari M., Robertson S.C., Pereira P., Zileli M., Anania C.D., Ferreira A., Ferrari S., Gatti R., Costa F. Conservative Treatment and Percutaneous Pain Relief Techniques in Patients with Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X. 2020 Jun 23; 7: 100079. DOI: 10.1016/j.wnsx.2020.100079. PMID: 32613192; PMCID: PMC7322792.

10. Drysch A., Ajiboye R.M., Sharma A., Li J., Reza T., Harley D., Park D.Y., Pourtaheri S. Effectiveness of Reoperations for Adjacent Segment Disease Following Lumbar Spinal Fusion. Orthopedics. 2018 Mar 1; 41(2): e161–e167. DOI: 10.3928/01477447-20170621-02. Epub 2017 Jun 30. PMID: 28662247.

11. Kanas M., Squassoni Leite M., Salvioni Ueta R.H. et al. Comparison of farfan modified and frobin methods to evaluate the intervertebral disc height. Coluna/Columna. 2014; 13(1): 31–34.

12. Liu X., Jin L., Jiang C., Jiang X., Chen Z., & Cao Y. Characteristics of cervical intervertebral disc signal intensity: an analysis of T2-weighted magnetic resonance imaging in 5843 asymptomatic Chinese subjects. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2023; 32(7): 2415–2424. DOI: 10.1007/s00586-023-07742-0

13. Frobin W., Brinckmann P., Biggemann M., Tillotson M., Burton K. Precision measurement of disc height, vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine. Clin Biomech (Bristol, Avon). 1997; 12(1): 1–63.