| Title: | P57. Adjacent segment disease (AdSD) after spinal fusion in the UK BioBank (UKB) |
| Journal: | The Spine Journal |
| Published: | 1 Sep 2024 |
| DOI: | https://doi.org/10.1016/j.spinee.2024.06.078 |
Publication 13138
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Abstract
BACKGROUND CONTEXT The prevalence of symptomatic spinal disease requiring fusion is increasing with an aging population. Patients are counseled there is a 3% annual risk of additional surgery due to AdSD, though this may not account for advances in surgical technique. The UKB is a large population-based cohort of 500,000 deidentified people, with in-depth genetic and nongenetic information, as well as linked hospital records. The database is regularly updated and includes >20 years of hospital records. We investigated the rate of AdSD after primary cervical and lumbar fusion in the UKB cohort, as well as risk factors that may contribute. PURPOSE The rate of AdSD in the cervical or lumbar spine will be less than 3% annually after primary fusion. STUDY DESIGN/SETTING Cohort study. PATIENT SAMPLE UK Biobank Cohort, 3,487 patients. OUTCOME MEASURES N/A METHODS UKB patients that underwent primary cervical or lumbar fusion were identified using OPCS-4 codes. AdSD was defined as subsequent fusion, revision, or decompression within the same spinal region as their primary surgery. Associations with risk factors were assessed using Cox regression. RESULTS A total of 3487 patients underwent primary fusion in the cervical (N=1732) or lumbar (N=1755) spine. 211 (12.1%) cervical and 230 (13.1%) lumbar patients were revised for AdSD. Five-year cumulative incidence for cervical and lumbar spine revision surgery was 8.19% and 10.16%. 20-year cumulative incidence for revision cervical and lumbar spine surgery was 19.67% and 19.79% respectively, amounting to an annual risk of ∼1%. Unemployed/Retired status achieved significance as a risk factor for AdSD in univariate (p=0.011) and multivariate analysis (p=0.0063). BMI, age, gender, race, tobacco use, area deprivation, and osteoporosis were not significant in univariate or multivariate models. CONCLUSIONS Our findings suggest the rate of AdSD in the cervical and lumbar spine is lower than previously reported, roughly 1% annually, with about half of the revisions occurring within the first 5 years. Occupational status as Unemployed/Retired was found to increase risk of developing AdSD, suggesting that decreased work activity may be indicative of greater disability and disease burden. The first 5 years has a higher rate of AdSD compared to the next 15 years. There may be underlying risk factors that account for the increased early rate of AdSD, such as genetic variation, spine characteristics, surgical factors, and medical comorbidities. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs.</p>
4 Authors
- Rohit Bhan
- Vy Pham
- Elizabeth Yanik
- Brian J. Neuman
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