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BioMed Research International
Volume 2017, Article ID 4385620, 13 pages
Review Article

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

1Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
2School of Medicine, National Yang-Ming University, Taipei, Taiwan
3Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
4Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheung Kung University, Tainan, Taiwan

Correspondence should be addressed to Cheng-Li Lin; moc.liamg@49ilgnej

Received 25 July 2016; Accepted 10 November 2016; Published 22 February 2017

Academic Editor: Jiancheng Zeng

Copyright © 2017 Po-Hsin Chou 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.


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 ASD at the proximal motion segments. However, higher quality prospective randomized trials are required prior to wide clinical application.