Spinal Metastatic Disease: Survival Analysis of 146 Patients and Evaluation of 4 Different Preoperative Scoring Systems.

STUDY DESIGN: This was a retrospective analysis. OBJECTIVE: The objective of this study was to evaluate the predictive value of the 4 different scoring systems Tomita, Bauer modified, Tokuhashi revised, and Van der Linden and some parameters that are used in these scoring systems. SUMMARY AND BACKGROUND DATA: Prediction of the survival period before treatment for spinal metastasis is extremely important. A lot of scoring systems have been described to predict the survival periods and to select the ideal treatment modality in the literature. MATERIALS AND METHODS: Retrospectively 146 patients with spinal metastasis were investigated between 2002 and 2011. The following parameters were analyzed: age, pathologic vertebra fracture, neurological deficit, visceral metastasis, diagnosis of primary tumor and its spinal metastasis interval, other skeletal metastasis, involved region of vertebra, and undergone spinal surgery. Patients were also scored by the 4 different scoring systems. The survival period was calculated from date of diagnosis of the spinal metastasis to the date of death or last follow-up (minimum: 12 mo). Cox regression, Kaplan-Meier survival test, and Cronbach α tests were performed for statistical analysis. RESULTS: Median overall survival for all patients was 13 months (range: 1-68 mo). The primary tumor (P=0.015), existence of visceral metastasis (P=0.017), presence of pathologic vertebra fracture (P=0.009), and undergone spinal surgery (P=0.047) showed significant influence on survival. Each scoring system was reliable and concordant with the other scoring systems (Cronbach α=80%); however, after 2 years, Modified Bauer score appeared to be the most reliable system for predicting survival (Cronbach α=25%). CONCLUSIONS: According to this analysis, lung cancer, visceral metastasis, pathologic vertebra fracture, and undergone spinal surgery have shown a negative effect on survival. All 4 scoring systems were reliable for predicting survival of patients with spinal metastatic disease. However, modified Bauer scoring system seems to be more predictive after 2 years. LEVEL OF EVIDENCE: Level III.

Effect of PLIF and TLIF on sagittal spinopelvic balance of patients with degenerative spondylolisthesis.

OBJECTIVE: The aim of this study was to evaluate the effects of PLIF and TLIF on sagittal spinopelvic balance and to compare radiological results of two surgical procedures with regard to spinopelvic parameters. METHODS: Thirty-five patients (34 female and 1 male; mean age: 52.29 ± 13.08 (range: 35-75)) with degenerative spondylolisthesis cases were included in the study. Patients were divided into two groups according to surgical technique: PLIF and TLIF. The level and the severity of listhesis according to Meyerding classification were assessed and spinopelvic parameters including sacral slope, pelvic tilt, pelvic incidence (PI), lumbar lordosis, and segmental lumbar lordosis were measured on digital X-rays. All preoperative and postoperative parameters and the results were compared between two groups. RESULTS: The age distribution was similar in both groups (p = 0.825) and there was no difference between the mean PI of the groups (p = 0.616). In 15 patients, spondylolisthesis level were at the L5-S1 level (PLIF: 8, TLIF: 7), in 16 patients at the L4-L5 level (PLIF: 6, TLIF: 10) and in 4 patients at the L3-L4 level (PLIF: 2, TLIF: 2). According to Meyerding classification, before the operation, the sliding grades were 0 in 4 patients, 1 in 21 patients, 2 in 7 patients, and 3 in 3 patients. The grades changed into 0 in 28 patients, 1 in 5 patients, and 2 in 2 patients after surgery. There were no differences in the grade of listhesis between PLIF and TLIF groups preoperatively (p = 0.190) and postoperatively (p = 0.208). In both groups, the spondylolisthesis-related deformities of patients were significantly corrected after surgery (p < 0.001). CONCLUSION: PLIF and TLIF techniques have similar radiological results in restoring the sagittal spinopelvic balance in patients with degenerative spondylolisthesis. Both techniques are good options to achieve reduction and fusion in patients with degenerative spondylolisthesis, but have no advantage over each other for restoring spinopelvic balance. LEVEL OF EVIDENCE: Level III, Therapeutic study.

Restoration of pull-out strength of the failed pedicle screw: biomechanical comparison of calcium sulfate vs polymethylmethacrylate augmentation.

OBJECTIVE: The aim of the present study was to compare calcium sulfate (CAS) and polymethylmethacrylate (PMMA) bone cements used for the augmentation of a failed pedicle screw with biomechanical pull-out strength (POS) testing. METHODS: Thirty lumbar vertebrae were harvested from 6 calves and bone mineral densities (BMD) were measured. Primary polyaxial pedicle screws were randomly inserted and pulled out and the POSs of the specimen were recorded. For revision, specimens were randomly assigned to the CAS-augmented pedicle screws group (Group 1) or PMMA-augmented pedicle screw group (Group 2). Pull-out tests were repeated to compare both groups. RESULTS: Mean BMD of the specimens was 1.006 ± 0.116 g/cm(2). There were no statistically significant differences between BMD results of the two groups (p=0.116). For Group 1, mean POS of primary screws was 2,441.3 ± 936.4 N and was 2,499.5 ± 1,425.1 N after CAS augmentation, demonstrating no statistically significant difference (p=0.865). In Group 2, mean POS of the primary screws was 2,876.6 ± 926.6 N and significantly increased to 3,745.5 ± 1,299.2 N after PMMA augmentation (p=0.047). There was also a significant difference in mean POS between the CAS and PMMA groups (p=0.026). CONCLUSION: Although CAS augmentation facilitates a revision screw POS as strong as that of primary screws, it is not as strong as PMMA augmentation.

The effects of extracorporeal shock waves on carrageenan-induced Achilles tendinitis in rats: a biomechanical and histological analysis.

OBJECTIVE: The aim of this study was to investigate the influence of low-dose extracorporeal shock waves (ESW) on the healing potential of Achilles tendinitis in the rat. METHODS: The 36 adult Sprague-Dawley rats used in this study were randomly divided into four groups. Group A (n=10) were injected with carrageenan, Group B (n=10) were injected with carrageenan and received ESW, Group C (n=10) received ESW only, and Group D (n=6) was a sham group. Rats were injected with 10 microliters of 3% carrageenan or a saline solution eight times during a one-week period with a subcutaneous needle. One week following the final injection, ESW was applied at a rate of 500 impulses in 5 minutes at 2 bars (comparative to 0.09 mJ/mm²) to rats in Groups B and C. Rats were sacrificed three weeks later. Tensile strength, inflammation, and vascularity and collagen density were measured. RESULTS: Failure of the tendon ultimate loads was significantly lower in the study groups than in the control group (p<0.05). Collagen fiber density was higher in the control group than in the other groups (p=0.59). No other histological differences were found. CONCLUSION: Low-dose ESW has a negative effect on tendon tensile strength in this animal model.

The effect of oophorectomy on epidural fibrosis after laminectomy: an experimental study in rats.

OBJECTIVE: The aim of this study was to examine the effect of oophorectomy in the formation of epidural fibrosis in a rat laminectomy model. METHODS: Thirty-six 12-month-old adult female Sprague-Dawley rats were used in this study. Rats were evenly divided into two groups; oophorectomized and sham-operated. Bilateral oophorectomy was performed on the 18 rats in the oophorectomized group. Three weeks after oophorectomy, rats in both groups underwent complete bilateral laminectomy at the L2 and L3 vertebral levels. Rats were divided into 3 equal groups and sacrificed in groups of 4 at the 4th, 8t, and 12th weeks postoperatively and the lumbar spine excised en bloc, fixed and decalcified. Sections were stained with hematoxylin and eosin and Masson's trichrome were used to evaluate epidural fibrosis, acute inflammation, chronic inflammation, and vascular proliferation. RESULTS: The mean histological sum grade of the epidural fibrosis was greater in the oophorectomized group (p>0.05). CONCLUSION: Endogenous estrogen could have an effect on epidural fibrosis formation after lumbar laminectomy in rats.

Revision of the failed pedicle screw in osteoporotic lumbar spine: biomechanical comparison of kyphoplasty versus transpedicular polymethylmethacrylate augmentation.

OBJECTIVES: In this study, we aimed to compare of kyphoplasty versus transpedicular polymethylmethacrylate (PMMA) augmentation biomechanically in the revision of the failed pedicle screw in osteoporotic lumbar spine. MATERIALS AND METHODS: Bone mineral density (BMD) of lumbar vertebrae collected from four bovines were measured. Each vertebra was decalcified with hydrochloric acid solution to obtain osteoporotic specimens. Primary polyaxial pedicle screws were inserted into the pedicles and pulled out until they failed. The pullout strength results of all specimens were recorded. Revision pedicle screws were randomly inserted into the same pedicles by either pedicle hole PMMA augmented (group 1) or kyphoplasty (Xvoid™) PMMA augmented pedicle screws (group 2). The pullout strength results of all specimens were re-recorded. RESULTS: The mean BMD significantly decreased from 1.686 ± 227.9 g/cm(2) to 1.432 ± 157.1 g/cm(2) following decalcification (p<0.001). In group 1, the mean pullout strength of primary screws significantly decreased from 3443 ± 1086 N/m(2) to 2088 ± 924 N/m(2) following pedicle screw augmentation (p=0.006). In group 2, the mean pullout strength of primary screws decreased from 3702 ± 1063 N/m(2) to 3664 ± 1057 N/m(2) following kyphoplasty augmentation (p=0.934). Pedicle screw augmentation group achieved significantly lower pullout strength values than kyphoplasty pedicle hole augmentation group (p=0.002). CONCLUSION: Although pedicle hole PMMA augmentation is the gold standard for the failed screws in an osteoporotic bone, kyphoplasty augmented pedicle screw seems to be more effective method increasing the pullout strength.

Surgical treatment of the spinal stenosis with an interspinous distraction device: do we really restore the foraminal height?

AIM: The aim of implantation of interspinous device is to unload the facet joints, restore foraminal height and provide stability in order to improve the clinical outcome of surgery. MATERIAL AND METHODS: After microsurgical decompression, Coflex™ device was applied. Patients were evaluated at a month after surgery and last follow-up using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). Foraminal height and lumbar lordosis angle were recorded. RESULTS: The mean preoperative VAS was 7.85 and fell to 1.7 a month after surgery (p < 0.0001). At the last follow-up the mean VAS score was 1.65 (p < 0.0001). The mean foraminal heights were measured 19.95 mm preoperatively and 25.05 mm a month after surgery (p < 0.0001). The mean foraminal height was 21.60 mm at the last follow-up (p=0.002). The mean lumbar lordosis were measured 32.05 and 34.3 degrees at preoperative and a month after surgery respectively (p=0.155). The mean lumbar lordosis was 32 (±5.99) degrees at the last follow-up (p=0.974). CONCLUSION: Using the Coflex device is a minimal invasive, effective and safe procedure. Restoration of the foraminal height may not be a responsible factor for clinical improvement. We think microsurgical decompression looks responsible of the good clinical outcome and using interspinous device is unnecessary. Comparative clinical studies can be informative.

Extracorporeal shock waves in articular cartilage defects in the rats.

Thirty adult Sprague-Dawley rats were used to assess the nature of healing tissues in hyaline cartilage defects and to compare the healing in defects treated with shock waves, with those in defects without treatment. A 2 × 2 mm cartilage defect with exposed cancellous bone was created in a nonweight-bearing area of each medial femoral condyle. Each right knee defect was received extracorporeal shock waves (Swiss Dolorclast) of 500 impulses in 5 min at 2 bar (comparative to 0.09 mJ/mm(2)), and the left knee defects were assigned as controls. The rat groups were sacrificed at 6 and 12 weeks postsurgery. Sections from each knee were stained with hematoxylin-eosin to analyze synovial adhesion, synovial thickness, bone maturation, and chondroid metaplasia and with masson trichrome to analyze collagen fiber intensity. There was not a significant difference found between the study and control groups (P > 0.05). Extracorporeal shock waves did not effect healing of the chondral defects.

The surgical treatment for a rare case of double-level isthmic spondylolisthesis in L4 and L5 lumbar spine: decompression, reduction and fusion.

An unusual case of a double-level isthmic spondylolisthesis of the lumbar spine in a 38-year-old female was described. The patient had been suffering from low back pain for 8 years and did not respond to conservative treatment. Her medical examination revealed that grade II isthmic spondylolisthesis was present both at L-4 to L-5 and at L-5 to S-1. The patient was managed by surgical treatment. After the reduction of lysthesis with posterior instrumentation, posterior lumbar interbody fusion (PLIF) technique was performed for double level. At a recent follow-up, 1 year after the surgery, the symptoms of the patient were completely resolved, reduction was preserved, and fusion was achieved. PLIF with posterior instrumentation and reduction seems to be a convenient treatment option in the treatment for double-level spondylolisthesis.

Irreducible dislocation of the knee joint: two-stage treatment.

Closed reduction attempts may be unsuccessful after traumatic knee dislocations on rare occasions. The interposition of the soft tissues on the medial aspect of the joint into the femoral condyle and tibial plateau is shown to be the cause of an unsuccessful reduction. In such cases, open reduction is the recommended method of treatment. In our study, we presented a 16-year-old male with an open knee dislocation after a motorcycle accident. As our closed reduction attempt failed, open joint reduction and repair of the medial collateral ligament and retinaculum was performed in the first stage of treatment. In the second stage, arthroscopic anterior cruciate ligament and posterior cruciate ligament reconstructions were carried out.

[Lumbar epidural steroid injection: Is the success rate predictable?]. / Epidural steroid enjeksiyonu: Basari tahmin edilebilir mi?

OBJECTIVES: The aim of this study was to determine the relation between the percent of canal compromise and success rate of epidural steroid injection (ESI) in patients with symptomatic lumbar herniated intervertebral discs. METHODS: Patients with lumbar herniated intervertebral disc suffering from leg pain and treated with ESI were selected. The axial magnetic resonance (MR) image showing the largest canal compromise by the herniated disc was selected for measurements. The canal area and disc herniation area measurements were calculated from the total number of pixels per cross-sectional area, multiplied by a scan correction factor, mm2/pixel. The percent canal compromise was obtained by the disc herniation area divided by the canal cross-section area, multiplied by 100. For pain assessment, visual analog scale (VAS) was used before (pre-injection VAS) and a month after ESI (post-injection VAS). Demographic data, duration of symptoms, and location and type of herniation were also noted. RESULTS: 39 patients (14 male, 25 female) were included in this study. The mean age was 50.2±11.6 years (27-76). Twenty-one cases (51%) also had back pain. The mean percent canal compromise ratio was 36.1±2.4%. The mean duration of symptoms was 19.4±6.6 months. The post-injection VAS was significantly decreased when compared with pre-injection VAS (p<0.0001), and this significance was related with the duration of symptoms being <3 months (p=0.021). There was also a significant negative correlation between percent canal compromise and post-injection VAS (p=0.042). However, there was no correlation between post-injection VAS and age, sex, or location or type of herniation (p>0.05). CONCLUSION: It has been demonstrated that higher benefits of ESI were achieved in patients with short duration of symptoms and high percent of canal compromise.

Tibiocalcaneal arthrodesis with posterior blade plate in diabetic neuroarthropthy.

BACKGROUND: To prevent amputation, achieving successfull ankle artrodesis in diabetic Charcot arthropaty patients is very important. As a salvage procedure, we have used a 95-degree-angled blade plate via a posterior approach to achieve tibiocalcaneal arthrodesis. MATERIALS AND METHODS: Between 2006 and 2008, four diabetic patients with hindfoot Charcot arthropathy underwent talectomy and tibiocalcaneal arthrodesis with an AO 95-degree-angled blade plate via a posterior approach. Two of the patients were male and two were female. The average age was 63 (range, 53 to 70) years. The mean duration of diabetes was 9 (range, 5 to 20) years. All the patients were on hemodialysis. Three of four patients had undergone previous surgeries. The average followup period was 24 (range, 12 to 35) months. RESULTS: Clinical and radiographic fusion was present by 5 (range, 3 to 6) months in three of four patients. In the other patient, a stable fibrous ankylosis was achieved. Clinical outcomes were excellent in three patients, and good in one patient. CONCLUSION: The performance of tibiocalcaneal arthrodesis with the use of blade plate with a posterior approach was a safe and successful surgical method for the treatment of Charcot ankle.

Bone pulsating metastasis due to renal cell carcinoma.

Pulsation on the bone cortex surface is a rare condition. Pulsative palpation of the superficial-located bone tumors can be misperceived as an aneurysm. Fifty-eight-year-old man is presented with pulsating bone mass in his proximal tibia. During angiographic examination, hypervascular masses were diagnosed both at right kidney and at right proximal tibia. Renal cell carcinoma was diagnosed after abdominal CT scan. Proximal tibia biopsy was complicated with projectile bleeding.

Non-tuberculous thoracic and lumbar spondylodiscitis: single-stage anterior debridement and reconstruction, combined with posterior instrumentation and grafting.

Debridement is warranted for the treatment of nontuberculous spondylodiscitis in case of neurological compromise, deformity, instability, abscess formation, extensive destruction, intractable pain or failure of medical management. The additional use of instrumentation is still controversial, but might fight infection and yield stability. The purpose of this retrospective study was to evaluate the outcome of 16 cases of non-tuberculous thoracic or lumbar spondylodiscitis treated with anterior debridement and reconstruction (tricortical graft or titanium mesh cage), combined with single-stage posterior instrumentation and grafting. The pathogens identified were: Brucella (5), coagulase-negative Staphylococcus aureus (4), Staphylococcus aureus (3), unidentified (4). All 16 infections resolved without recurrence. Bony union was obtained in all cases. Fourteen out of 16 patients (87.5%) were completely relieved of pain and fully active, an excellent result according to Macnab's criteria; the other two patients obtained a good result. All 7 patients who had a neurological deficit improved. There were two superficial infections, which healed with debridement and antibiotics. A single iliac vein injury was primarily repaired. In conclusion, the proposed technique is an effective and safe treatment for pyogenic spondylodiscitis, if surgery is mandatory.

Magnetic resonance imaging in the visualization of benign tumors and tumor-like lesions of hand and wrist.

The differential diagnosis of benign tumors and tumor-like lesions of the hand and wrist region is important with regard to choosing the therapy (medical versus surgical), or to decide to just follow-up the lesion. In most of the cases the proper analysis of MRI findings in correlation with the patient's history is sufficient to meet a specific diagnosis. However, diagnostic confusion is not uncommon as there are numerous lesions affecting the hand and wrist region. This pictorial essay offers a practical radiological approach to benign tumors and tumor-like lesions of the hand and wrist region based on most frequently observed MRI findings.

Comparison of arthroscopic capsular release in diabetic and idiopathic frozen shoulder patients.

INTRODUCTION: The clinical results of arthroscopic capsular release for frozen shoulder in diabetic (group 1) and idiopathic (group 2) patients were compared. Surgery was performed on 28 shoulders of 26 patients (24 women, 2 men) with frozen shoulder unresponsive to conservative treatment. The mean age was 50 (range 40-65). A total of 14 patients were included in group 1, and 12 were in group 2. The average duration of complaints was 10 and 7 months in groups 1 and 2, respectively. The evaluation of shoulder functions was made according to the University of California, Los Angeles (UCLA) and Constant Scoring Systems. Duration of complete pain relief and for regaining range of motion (ROM) after surgery were also noted in their final follow-up examination. RESULTS: The mean follow-up period was 48.5 and 60.2 months in group 1 and group 2, respectively. There was no significant difference between the two groups in terms of the postoperative duration of complete pain relief and that for regaining ROM (P > 0.05). The duration of complete pain relief was 2.6 and 2.5 months, and regaining of ROM was 1.6 and 1.5 months for groups 1 and 2, respectively. The postoperative UCLA and Constant scores had significant increases in both groups compared to the preoperative ones (P < 0.05). There was a significant difference between the groups in terms of Constant scores (P < 0.05) while there was no difference in terms of UCLA scores (P > 0.05). There was a statistically significant difference in shoulder abduction and internal rotation degrees between the groups (P < 0.05). CONCLUSION: The results of arthroscopic capsular release for frozen shoulder in diabetic patients had less good results in terms of range of motion and Constant-Score. There was no significant difference between the two groups in terms of the duration of pain relief and that of regaining the ROM.

[Elastofibroma dorsi: an unusual cause of shoulder pain]. / Elastofibroma dorsi: Nadir görülen bir omuz agrisi nedeni.

OBJECTIVES: We evaluated patients who underwent surgical treatment for elastofibroma dorsi (ED). METHODS: The study included 13 patients (11 women, 2 men; mean age 54 years; range 43 to 74 years) who were treated surgically for ED that caused persistent symptoms. Involvement was on the right in six patients, on the left in five patients, and bilateral in two patients. All the patients presented with a mass lesion that became apparent at the lower corner of the scapula on shoulder flexion and adduction. The complaints were swelling and pain on the back in nine patients, and a snapping sound on shoulder movements together with pain in four patients. Diagnosis of ED was made by magnetic resonance imaging (n=10) and computed tomography (n=3), with no utilization of preoperative biopsy. Marginal tumor excision was performed in all cases. Evaluation for recurrence was made by ultrasonography. The mean follow-up period was 32 months (range 8 to 90 months). RESULTS: All the masses were located at the inferior corner of the scapula, with adherence to the thorax between the serratus anterior, rhomboid, and latissimus dorsi muscles. The mean size of the surgical specimens was 9 x 6 x 3 cm (range 5 x 3 x 1 to 14 x 8 x 3 cm). Clinical diagnosis was confirmed by histopathologic examination in all cases. All major complaints resolved after surgery. Hematoma occurred in four cases postoperatively, but resolved without the need for surgical intervention. No recurrence was observed. CONCLUSION: Even though ED is a rare clinic entity, it should be recalled while evaluating shoulder pathologies. Marginal excision is adequate for the treatment of patients with sustaining complaints.

Posterior epidural mass: can a posteriorly migrated lumbar disc fragment mimic tumour, haematoma or abscess?

A 60-year-old woman complained of low back pain radiating to both buttocks and to the anterior aspect of the left thigh. MRI showed a left posterolateral epidural mass at the L1-L2 level. An epidural abscess was suspected, but the biochemistry was normal. Excision yielded complete relief of symptoms. Pathological examination demonstrated that the specimen was a migrated disc fragment. The authors found 29 other cases of disc migration to the posterior epidural space; two of these were at the thoracic level. Eleven of the 27 lumbar cases (40%) were complicated with Cauda Equina Syndrome (CES). MRI is the method of choice to make the diagnosis. The differential diagnosis includes tumour, haematoma and abscess.

[The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft]. / Hamstring tendon otogrefti ile yapilan ön çapraz bag rekonstrüksiyonunda iki farkli tespit yönteminin femoral kemik tünel genislemesi ve klinik sonuçlar üzerine etkisi.

OBJECTIVES: We investigated the effects of anatomic and non-anatomic tunnel fixations on femoral tunnel widening and clinical results in anterior cruciate ligament (ACL) reconstructions. METHODS: We retrospectively evaluated 35 patients who underwent arthroscopic ACL reconstruction with quadrupled hamstring tendon graft. Fixation was performed in the tunnel using the transcondylar RigidFix pin (group 1) in 18 patients (mean age 32 years), and from outside the tunnel using the EndoButton-CL device (group 2) in 17 patients (mean age 30 years). The patients were assessed using the IKDC (International Knee Documentation Committee) and Lysholm knee scores and tunnel widening was assessed by computed tomography. Ligament laxity was measured bilaterally using the Rolimeter knee tester. The mean follow-up was 24 months (range 21 to 38 months) in group 1, and 24.6 months (range 12 to 36 months) in group 2. RESULTS: The two groups were similar with respect to age and sex distribution, operated side, the size of the tunnel created, and follow-up period (p>0.05). Postoperative knee scores did not show a significant difference (p>0.05). There was marked and excessive tunnel enlargement in 14 patients (77.8%) in group 1, and in 15 patients (88.2%) in group 2, with no significant difference between the two groups (p>0.05). Ligament laxity exceeded 3 mm in eight patients (44.4%) in group 1, and in three patients (17.7%) in group 2 (p<0.001). There was no relationship between tunnel widening and ligament laxity (p>0.05; r=0.175 and r=-0.01 for group 1 and group 2, respectively). CONCLUSION: Our results suggest that differences in the localization of the tunnel fixation have no effect on tunnel enlargement and that joint laxity may be affected by biomechanical properties of fixation materials.

Degeneration of non-fused segments after floating lumbar fusion.

Degeneration of the disc or discs between two fused spinal segments has been termed "floating disc disease". The purpose of this retrospective study was to show the radiological evolution of the floating disc(s) and the relationship between floating disc degeneration and segmental lordosis, lumbar lordosis and pelvic incidence. Twenty patients, with a mean age of 49.9 years, with symptomatic lumbar degenerative disc disease or low grade spondylolisthesis, who failed non-operative treatment and underwent fusion of 2 or more noncontiguous spinal segments, were included in this study. The radiographs of the floating discs were graded with the modified Gore System. The mean follow-up was 4.2 years. Forty-seven levels were fused and 27 floating discs were studied (13 single, 7 double). Five out of 27 floating discs (18%), in 4 patients, progressively degenerated. None of the floating discs degenerated more than two radiographic grades and none needed additional surgery. Postoperatively, 3 out of 5 degenerated floating discs had decreased segmental lordosis, while the other two had no change; this difference was not significant (p = 0.08). Neither was there any significant correlation between floating disc degeneration and lumbar lordosis L1-S1 (p > 0.10) or pelvic incidence (p > 0.10). This study shows that the effect of floating fusion on floating discs is the same as the effect of a contiguous fusion on adjacent discs.