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Title: Does laminectomy increase the rate of adjacent segment disease?

Macquarie Neurosurgery

Evidence Based Surgery presentation

Date: 24/5/2012

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Clinical case

• 67 yo male• Hx of previous laminectomy done elsewhere• Presented with symptoms related to

degeneration at the level above the laminectomy

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Searchable question (PICO format)

• P= patients with back pain• I= laminectomy• C= fusion• O= rate of ASD

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Search strategy

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Search results

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Gibson JN, Waddell G: Surgery for degenerativelumbar spondylosis: updated Cochrane Review.Spine (Phila Pa 1976) 30:2312-2320, 2005.

Level II

Shenkin HA, Hash CJ: Spondylolisthesis after multiplebilateral laminectomies and facetectomies forlumbar spondylosis: follow-up review. J Neurosurg50:45-47, 1979.

Level IV

Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH,LiangMH:Seven- to 10-year outcome of decompressivesurgery for degenerative lumbar spinal stenosis.Spine (Phila Pa 1976) 21:92-98, 1996.

Level IV

Malter AD,McNeneyB, Loeser JD, Deyo RA: 5-year reoperationrates after different types oflumbarspine surgery.Spine (Phila Pa 1976) 23:814-820, 1998.

Level IV

Aiki H, Ohwada O, Kobayashi H, Hayakawa M,Kawaguchi S, Takebayashi T, Yamashita T: Adjacentsegment stenosis after lumbar fusion requiring secondoperation. J Orthop Sci 10:490-495, 2005.

Level IV

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Rahm MD, Hall BB: Adjacent-segment degenerationafter lumbar fusion with instrumentation: a retrospectivestudy. J Spinal Disord 9:392-400, 1996.

Level IV

Reoperation after decompression for lumbar spine stenosis. Lam

Level IV

A comparison of unilateral and bilateral laminotomies for decompression of L4/5 stenosis. Hong

Level IV

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Discussion/Results

• There is no paper who has looked at damage to adjacent level facet complex for laminectomy alone while this data are available for laminectomy above a fusion

• Preoperative data on preexisting adjacent level disease prior to laminectomy have not been recorded

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• Different techniques in laminectomy also seem to influence reoperation and adjacent level disease rate (i.e. splitting of the spinous process, undercutting of the spinous process with unilateral dissection, modified bilateral laminectomy, unilateral hemilaminectomy.

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Conclusions• There is some evidence that some of the reoperation

for lumbar laminectomy include problems related to the level adjacent to this procedure

• There are no sufficient data in the literature to suggest that laminectomies could be responsible for ASD but there is some suggestions that “some” laminectomies could be done in a way that predisposes patient to the development of ASD (i.e. violation of neighbouring facet-ligamentous complex)

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Conclusion 2

• It would be useful to record the specific reason for reoperation after laminectomy and thoroughly look at the data set to evaluate rate and causes for ASD after laminectomy.

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Thanks!