Topping-off surgery vs posterior lumbar interbody fusion for degenerative lumbar disease: a comparative study of clinical efficacy and adjacent segment degeneration

Abstract

Abstract Background Studies have shown that adjacent segment degeneration (ASD) is a common complication after posterior lumbar interbody fusion (PLIF), even a second surgery is required for some patients. It remains unclear whether the non-fusion surgery can relieve ASD. Therefore, this study aims to investigate the clinical outcomes of Topping-off surgery (fusion combined with Coflex) and PLIF for degenerative lumbar disease (DLD) and the efficacy on preventing ASD. Method A retrospective analysis was performed on the clinical data of 99 patients with DLD from January 2011 to December 2014, who were performed by Topping-off surgery (L4–5 PLIF + L3–4 Coflex, n = 45) or PLIF (L3–5 PLIF, n = 54). All patients included in the analysis had a minimum of 3 years of follow-up. Clinical data were used to assess the clinical efficacy, and radiographic parameters were measured for evaluation of the incidence of ASD. Results The mean ages of Topping-off group and PLIF group were 53.5 and 65.7 years old, respectively (P 0.05), while that of PLIF group was increased considerably (P 0.05). Lumbar MRI at three post-operative years indicated that the modified Pfirrman grading of disc (L2–L3) in the Topping-off group was much better than that of the PLIF group (P < 0.05). Conclusion This study showed that Topping-off surgery had the benefits of less invasiveness, less bleeding, and comparable clinical efficacy as PLIF for DLD. The segment with Coflex insertion undertook part of the mobility and stress in the proximal lumbar spine, which is conducive to alleviating ASD.

Keywords

• Topping-off
• Coflex
• Posterior lumbar interbody fusion (PLIF)
• Degenerative lumbar disease (DLD)
• Clinical efficacy
• Adjacent segment degeneration (ASD)