Could the topping-off technique be the preventive strategy against adjacent segment disease after pedicle screw-based fusion in lumbar degenerative diseases? A systematic review

Po Hsin Chou, Hsi Hsien Lin, Howard S. An, Kang Ying Liu, Wei-Ren Su, Cheng-Li Lin

Research output: Contribution to journalReview article

Abstract

The "topping-off" technique is a new concept applying dynamic or less rigid fixation such as hybrid stabilization device (HSD) or interspinous process device (IPD) for the purpose of avoiding adjacent segment disease (ASD) proximal to the fusion construct. A systematic review of the literature was performed on the effect of topping-off techniques to prevent or decrease the occurrence of ASD after lumbar fusion surgery.We searched through major online databases, PubMed and MEDLINE, using key words related to "topping-off" technique. We reviewed the surgical results of "topping-off" techniques with either HSD or IPD, including the incidence of ASD at two proximal adjacent levels (index and supra-adjacent level) as compared to the fusion alone group. The results showed that the fusion alone group had statistically higher incidence of radiographic (52.6%) and symptomatic (11.6%) ASD at the index level as well as higher incidence (8.1%) of revision surgery. Besides, the HSD (10.5%) and fusion groups (24.7%) had statistically higher incidences of radiographic ASD at supra-adjacent level than the IPD (1%). The findings suggest that the "topping-off" technique may potentially decrease the occurrence of ASDat the proximalmotion segments.However, higher quality prospective randomized trials are required prior to wide clinical application.

Original languageEnglish
Article number4385620
JournalBioMed research international
Volume2017
DOIs
Publication statusPublished - 2017 Jan 1

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Fusion reactions
Equipment and Supplies
Stabilization
Surgery
Incidence
Reoperation
PubMed
MEDLINE
Pedicle Screws
Databases

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Microbiology(all)

Cite this

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title = "Could the topping-off technique be the preventive strategy against adjacent segment disease after pedicle screw-based fusion in lumbar degenerative diseases? A systematic review",
abstract = "The {"}topping-off{"} technique is a new concept applying dynamic or less rigid fixation such as hybrid stabilization device (HSD) or interspinous process device (IPD) for the purpose of avoiding adjacent segment disease (ASD) proximal to the fusion construct. A systematic review of the literature was performed on the effect of topping-off techniques to prevent or decrease the occurrence of ASD after lumbar fusion surgery.We searched through major online databases, PubMed and MEDLINE, using key words related to {"}topping-off{"} technique. We reviewed the surgical results of {"}topping-off{"} techniques with either HSD or IPD, including the incidence of ASD at two proximal adjacent levels (index and supra-adjacent level) as compared to the fusion alone group. The results showed that the fusion alone group had statistically higher incidence of radiographic (52.6{\%}) and symptomatic (11.6{\%}) ASD at the index level as well as higher incidence (8.1{\%}) of revision surgery. Besides, the HSD (10.5{\%}) and fusion groups (24.7{\%}) had statistically higher incidences of radiographic ASD at supra-adjacent level than the IPD (1{\%}). The findings suggest that the {"}topping-off{"} technique may potentially decrease the occurrence of ASDat the proximalmotion segments.However, higher quality prospective randomized trials are required prior to wide clinical application.",
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Could the topping-off technique be the preventive strategy against adjacent segment disease after pedicle screw-based fusion in lumbar degenerative diseases? A systematic review. / Chou, Po Hsin; Lin, Hsi Hsien; An, Howard S.; Liu, Kang Ying; Su, Wei-Ren; Lin, Cheng-Li.

In: BioMed research international, Vol. 2017, 4385620, 01.01.2017.

Research output: Contribution to journalReview article

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AU - Su, Wei-Ren

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