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BioMed Research International
Volume 2017 (2017), Article ID 2964529, 9 pages
Review Article

Pathoanatomic Risk Factors for Instability and Adjacent Segment Disease in Lumbar Spine: How to Use Topping Off?

1Center for Spinal Surgery, Schön Klinik Düsseldorf SE & Co. KG, Am Heerdter Krankenhaus 2, 40549 Düsseldorf, Germany
2Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
3Department of Orthopedics, Medical Center City Aachen GmBH, Wuerselen, Germany

Correspondence should be addressed to J. Bredow

Received 21 November 2016; Accepted 4 July 2017; Published 31 July 2017

Academic Editor: Panagiotis Korovessis

Copyright © 2017 J. Bredow et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. The goal of this review is to identify criteria indicating implantation of hybrid system into lumbar spine and to evaluate general benefits of use. Methods. A systematic review of literature was performed using current randomized clinical trials, reviews, and meta-analyses. Data sources included relevant literature of human studies identified through searches of Medline Library until May 2015. Results. Predisposing factors for Adjacent Segment Disease (ASDi) are discussed in literature: laminar horizontalization, insufficiency of fascia thoracolumbalis, facet tropism, and facet sagittalization. Currently there is no evidence for topping off. There are only 12 studies and these have no consistent statements about use of a hybrid system for avoidance of ASDi. Conclusion. Hybrid instrumentation of lumbar spine, either with pedicle-based technique or additional spacer, might possibly prevent ASDi from developing in previously damaged segment adjacent to a fusion. Good clinical data proving effectiveness of this new implant technique is as yet unavailable. Thus, currently one must speak of an unevaluated procedure. Various radiological classifications can assist in making a reliable decision as to whether hybrid instrumentation is an appropriate choice of therapy. Pathoanatomical conditions of facet joints and laminae as well as preservation of sagittal balance must also be considered.