ArticleJournal of orthopaedic surgery and research2019
Topping-off surgery vs posterior lumbar interbody fusion for degenerative lumbar disease: a comparative study of clinical efficacy and adjacent segment degeneration.
Article in Journal of orthopaedic surgery and research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 25 citations in OpenAlex.
- Pooled it
- Topping-Off Technology versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation: A Meta-Analysis.BioMed research international · 2020Pooled it
- Addition of Celebrex and Pregabalin to Ropivacaine for Posterior Spinal Surgery: A Randomized, Double-Blinded, Placebo-Controlled Trial.Drug design, development and therapy · 2021Trial
- Low-Profile Posterior Lumbar Fusion Combined With Proximal Interlaminar Coflex Dynamic Fixation for Lumbar Degenerative Diseases: A Comparative Study.Orthopaedic surgery · 2026Article
- Effectiveness of Hybrid Surgery Using Polyetheretherketone Rods for Preventing Proximal Junctional Kyphosis and Failure After Adult Spinal Deformity Surgery: Biomechanical Evaluation.Scientific reports · 2026Article
- The influence of the interfacing angle between the pedicle screw and support rods on the clinical outcomes after posterior lumbar-sacral topping-off surgery: A retrospective clinical study.Journal of orthopaedic surgery and research · 2025Observational
- The clinical efficacy of hybrid surgery based on the Waveflex semi-rigid dynamic internal fixation system for the treatment of lumbar degenerative diseases: over three-year follow-up study.BMC musculoskeletal disorders · 2025Article
- Effectiveness of Interspinous Process Devices in Managing Adjacent Segment Degeneration Following Lumbar Spinal Fusion: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2024Review
- Preoperative Nutritional Status Screened by MNA-SF Predicts Major Complications in Elderly Patients Undergoing Lumbar Fusion Surgery.Clinical interventions in aging · 2024Article
- The effect of interlaminar Coflex stabilization in the topping-off procedure on local and global spinal sagittal alignment.BMC musculoskeletal disorders · 2023Article
- Comparison of long-term outcomes of spinal fusion surgeries supplemented with "topping-off" implants in lumbar degenerative diseases: A systematic review and network meta-analysis.North American Spine Society journal · 2022Review
- Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion: Technique Note and Comparison of Early Outcomes with Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis.International journal of general medicine · 2021Article
- New combination of IntraSPINE device and posterior lumbar interbody fusion for rare skipped-level lumbar disc herniation: a case report and literature review.The Journal of international medical research · 2020Review
- Biomechanical changes of degenerated adjacent segment and intact lumbar spine after lumbosacral topping-off surgery: a three-dimensional finite element analysis.BMC musculoskeletal disorders · 2020Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundStudies 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.
methodA 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.
resultsThe mean ages of Topping-off group and PLIF group were 53.5 and 65.7 years old, respectively (P < 0.05). The surgical time, intraoperative blood loss, Oswestry disability index (ODI), and visual analog scale (VAS) were significantly different between the two groups (P < 0.05). Intervertebral mobility (L2-L3) of the Topping-off group was not changed significantly at 3 years after surgery than before (P > 0.05), while that of PLIF group was increased considerably (P < 0.05). As to intergroup comparison, intervertebral mobility (L2-L3) of Topping-off group was superior to those of the PLIF group (P < 0.05). Surprisingly, there was no significant difference in the general adjacent segment mobility (GASM) at L2-4 of the Topping-off group and intervertebral mobility (L2-L3) of PLIF group at 3 years after surgery (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).
conclusionThis 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.