This document summarizes a presentation on whether laminectomy increases the rate of adjacent segment disease. It describes a clinical case of a 67-year-old male with previous laminectomy presenting with symptoms above the laminectomy level. It outlines the search strategy and results, which found some evidence that reoperations after laminectomy sometimes involve adjacent level problems, but no conclusive data that laminectomy alone causes adjacent segment disease. The conclusions state that different laminectomy techniques may influence outcomes and more data is needed analyzing reoperation reasons and adjacent segment disease rates after laminectomy.

1. Title: Does laminectomy increase the
rate of adjacent segment disease?
Macquarie Neurosurgery
Evidence Based Surgery presentation
Date: 24/5/2012
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2. 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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3. Searchable question (PICO format)
• P= patients with back pain
• I= laminectomy
• C= fusion
• O= rate of ASD
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7. Search strategy
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12. Search results
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14. Gibson JN, Waddell G: Surgery for degenerative Level II
lumbar spondylosis: updated Cochrane Review.
Spine (Phila Pa 1976) 30:2312-2320, 2005.
Shenkin HA, Hash CJ: Spondylolisthesis after multiple Level IV
bilateral laminectomies and facetectomies for
lumbar spondylosis: follow-up review. J Neurosurg
50:45-47, 1979.
Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Level IV
LiangMH:Seven- to 10-year outcome of decompressive
surgery for degenerative lumbar spinal stenosis.
Spine (Phila Pa 1976) 21:92-98, 1996.
Malter AD,McNeneyB, Loeser JD, Deyo RA: 5-year Level IV
reoperation
rates after different types oflumbarspine surgery.
Spine (Phila Pa 1976) 23:814-820, 1998.
Aiki H, Ohwada O, Kobayashi H, Hayakawa M, Level IV
Kawaguchi S, Takebayashi T, Yamashita T: Adjacent
segment stenosis after lumbar fusion requiring second
operation. J Orthop Sci 10:490-495, 2005.
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15. Rahm MD, Hall BB: Adjacent-segment degeneration Level IV
after lumbar fusion with instrumentation: a retrospective
study. J Spinal Disord 9:392-400, 1996.
Reoperation after decompression for lumbar spine Level IV
stenosis. Lam
A comparison of unilateral and bilateral laminotomies for Level IV
decompression of L4/5 stenosis. Hong
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16. 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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17. • 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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18. 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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19. 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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20. Thanks!
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