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Takeuchi S, Inoue T, Takahashi T, Kanematsu R, Minami M, Hanakita J. The Effectiveness of Tritanium Cages in Preventing Osteolytic Vertebral Endplate Cysts After Lumbar Interbody Fusion. World Neurosurg 2024; 184:e803-e808. [PMID: 38369108 DOI: 10.1016/j.wneu.2024.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE Lumbar interbody fusion (LIF) is a common surgical procedure, but postoperative complications, such as osteolytic vertebral endplate cysts, can adversely affect patient outcomes. This study aims to investigate whether tritanium cages (Stryker, Mahwah, New Jersey, USA) are effective in preventing osteolytic vertebral endplate cysts after LIF. METHODS Clinical data from 8 years (2013-2020) of LIF procedures at our hospital were analyzed. Computed tomography was used to assess the formation of osteolytic vertebral endplate cysts 6 months after surgery. Clinical factors potentially associated with cyst formation were compared among 3 different interbody spacer materials: tritanium, titanium, and polyetheretherketone. RESULTS LIF was performed for 169 patients at 205 spinal levels, employing tritanium cages in 56 levels (48 patients), titanium in 103 levels (86 patients), and polyetheretherketone in 46 levels (35 patients). At 6 months after LIF, 27.3% of patients showed worsening of osteolytic vertebral endplate cysts. Multivariate logistic regression analysis showed that tritanium cages (odds ratio [OR], 3.86; 95% confidence interval [CI], 1.46-10.21) and titanium (OR, 2.55; 95% CI, 1.13-5.75), and posterior LIF (OR, 5.74; 95% CI, 2.24-14.74) were associated with a reduced risk of postoperative osteolytic vertebral endplate cysts. CONCLUSIONS Tritanium cages have shown promise in preventing postoperative osteolytic vertebral endplate cysts, suggesting their potential as a stable and effective choice in LIF procedures. These findings have significant implications for improving patient outcomes and warrant further investigation to optimize surgical techniques and materials.
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Affiliation(s)
- Shu Takeuchi
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan; Department of Neurosurgery, Hikone Municipal Hospital, Hikone, Shiga, Japan
| | - Tomoo Inoue
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan; Department of Neurosurgery, Saitama Red Cross Hospital, Saitama, Saitama, Japan.
| | - Toshiyuki Takahashi
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan
| | - Ryo Kanematsu
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan
| | - Manabu Minami
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan
| | - Junya Hanakita
- Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Shizuoka, Japan
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Park SC, Bae JS, Jung SO, Sung KH, Chung HJ. Comparison of Unilateral versus Bilateral Instrumented Transforaminal Lumbar Interbody Fusion in Lumbar Degenerative Diseases: A Minimum of 5-Year Follow-Up. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1898. [PMID: 38003948 PMCID: PMC10673228 DOI: 10.3390/medicina59111898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023]
Abstract
Background and Objective: There is a paucity of literature comparing unilateral instrumented transforaminal lumbar interbody fusion (UITLIF) with bilateral instrumented TLIF (BITLIF) regarding radiological alignment, including the coronal balance, even though UITLIF might have asymmetric characteristics in the coronal plane. This retrospective study aimed to compare the clinical and long-term radiological outcomes of 1-level UITLIF and BITLIF in lumbar degenerative diseases (LDD) including lumbar spinal stenosis with or without spondylolisthesis (degenerative or spondylolytic). Materials and Methods: Patients who underwent 1-level UITLIF with two rectangular polyetheretherketone (PEEK) cages or BITLIF between November 2009 and June 2016 by four surgeons with ≥5 years of follow-up at a single hospital were included. We compared the clinical and radiological outcomes between the UITLIF and BITLIF. Results: In total, 63 and 111 patients who underwent UITLIF and BITLIF, respectively, were enrolled. The median follow-up was 85.55 months (range: 60-130). The UITLIF group had a significantly shorter operation time (185.0 [170.0-210.0] vs. 225.0 [200.0-265.0], p < 0.001) and lower estimated blood loss (300.0 [250.0-500.0] vs. 550.0 [400.0-800.0], p < 0.001) than the BITLIF group. Regarding the clinical outcomes, there were no significant differences in the intermittent claudication score (p = 0.495) and Kirkaldy-Willis criteria (p = 0.707) at 1 year postoperatively. The interval changes in the local coronal Cobb angle at the index level, L1-S1 lordotic angle, and coronal off-balance from the immediate postoperative radiograph to the last follow-up were not significantly different (p = 0.687, p = 0.701, and p = 0.367, respectively). Conclusions: UITLIF with two rectangular PEEK cages may provide comparable clinical outcomes and radiological longevity including coronal alignment to BITLIF in 1-level LDD. In addition, UITLIF has advantages over BITLIF in terms of operative time and blood loss.
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Affiliation(s)
- Sung Cheol Park
- Department of Orthopedic Surgery, Bumin Hospital Seoul, Seoul 07590, Republic of Korea;
| | - Jae Seong Bae
- Department of Spine Surgery, Seoul 21st Century Spine Hospital, Seoul 06654, Republic of Korea; (J.S.B.); (S.O.J.); (K.-H.S.)
| | - Seon Ok Jung
- Department of Spine Surgery, Seoul 21st Century Spine Hospital, Seoul 06654, Republic of Korea; (J.S.B.); (S.O.J.); (K.-H.S.)
| | - Kyeong-Hoon Sung
- Department of Spine Surgery, Seoul 21st Century Spine Hospital, Seoul 06654, Republic of Korea; (J.S.B.); (S.O.J.); (K.-H.S.)
| | - Hoon-Jae Chung
- Department of Orthopedic Surgery, Bumin Hospital Seoul, Seoul 07590, Republic of Korea;
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Pan A, Hai Y, Lenke LG, Zheng Z, Yang J. Apical Vertebras Distribution Modifier for Coronal Balance Classification in Adult Idiopathic Scoliosis. J Pers Med 2023; 13:897. [PMID: 37373886 DOI: 10.3390/jpm13060897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/08/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Background: We aimed to propose the apical vertebras distribution modifier to supplement the coronal balance (CB) classification for adult idiopathic scoliosis (AdIS). An algorithm to predict postoperative coronal compensation and avoid postoperative coronal imbalance (CIB) was proposed. Methods: Patients were categorized into CB and CIB groups according to the preoperative coronal balance distance (CBD). The apical vertebras distribution modifier was defined as negative (-) if the centers of the apical vertebras (CoAVs) were on either side of the central sacral vertical line (CSVL) and positive (+) if the CoAVs were on the same side of the CSVL. Results: A total of 80 AdIS patients, with an average age of 25.97 ± 9.20 years, who underwent posterior spinal fusion (PSF) were prospectively recruited. The mean Cobb angle of the main curve was 107.25 ± 21.11 degrees at preoperation. The mean follow-up time was 3.76 ± 1.38 (2-8) years. At postoperation and follow-up, CIB occurred in 7 (70%) and 4 (40%) CB- patients, 23 (50%) and 13 (28.26%) CB+ patients, 6 (60%) and 6 (60%) CIB- patients, and 9 (64.29%) and 10 (71.43%) CIB+ patients. Health-related quality of life (HRQoL) was significantly better in the CIB- group compared with that of the CIB+ group in the dimension of back pain. To avoid postoperative CIB, the correction rate of the main curve (CRMC) should match the compensatory curve for CB-/+ patients; the CRMC should be greater than the compensatory curve for CIB- patients; and the CRMC should be less than the compensatory curve for CIB+ patients, and the inclination of the LIV needs to be reduced. Conclusions: CB+ patients have the least postoperative CIB rate and the best coronal compensatory ability. CIB+ patients are at a high risk of postoperative CIB and have the poorest coronal compensatory capacity in the event of postoperative CIB. The proposed surgical algorithm facilitates the handling of each type of coronal alignment.
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Affiliation(s)
- Aixing Pan
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Yong Hai
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Lawrence G Lenke
- New York-Presbyterian Och Spine Hospital, New York, NY 10034, USA
| | - Zhaomin Zheng
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510062, China
| | - Jincai Yang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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Wang DF, Chen XL, Han D, Kong C, Lu SB. The effect of sagittal alignment, coronal balance, and segmental stability on preoperative patient-reported outcomes in patients with degenerative lumbar spondylolisthesis. BMC Surg 2023; 23:48. [PMID: 36882802 PMCID: PMC9990298 DOI: 10.1186/s12893-023-01947-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate the association between spinal alignment and preoperative patient-reported outcomes (PROs) in patients with degenerative lumbar spondylolisthesis (DLS) and to identify the independent risk factors for worse preoperative PROs. METHODS In total, 101 patients suffering from DLS were retrospectively studied within a single medical center. Age, sex, height, weight, and body mass index were uniformly recorded. PRO-related indicators include the Oswestry Disability Index (ODI), the Japanese Orthopedic Association's (JOA) score, and the visual analog scale (VAS) for back and leg pain. Sagittal alignment, coronal balance, and stability of the L4/5 level were evaluated through whole-spine anteroposterior and lateral radiographs and dynamic lumbar X-ray. RESULTS Increasing age (P = 0.005), higher sagittal vertical axis (SVA) (P < 0.001), and global coronal imbalance (GCI) (P = 0.023) were independent risk factors for higher ODI. Patients with GCI had lower JOA scores (P = 0.001) than those with balanced coronal alignment. Unstable spondylolisthesis (P < 0.001) and GCI (P = 0.009) were two vital predictors of VAS-back pain. Increasing age (P = 0.031), local coronal imbalance (LCI) (P < 0.001), and GCI (P < 0.001) were associated with higher VAS-leg pain. Moreover, patients with coronal imbalance also exhibited significant sagittal malalignment based on the subgroup analysis. CONCLUSION DLS patients with higher SVA, unstable spondylolistheses, a combination of LCI/GCI, or increasing age were predisposed to have more severe subjective symptoms before surgery.
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Affiliation(s)
- Dong-Fan Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Center for Clinical Research On Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Xiao-Long Chen
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Center for Clinical Research On Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Di Han
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Center for Clinical Research On Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China.,National Center for Clinical Research On Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China. .,National Center for Clinical Research On Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China.
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Zhan X, Zhan X, Yu J, Moore G, Li F, Xi X, Zeng Z, Yin S, Yu Y, Cheng L. Correlation between direction of pedicle screw and restoration of lumbar degenerative scoliosis in degenerative lumbar spondylolisthesis: a retrospective study. Quant Imaging Med Surg 2023; 13:1740-1752. [PMID: 36915359 PMCID: PMC10006100 DOI: 10.21037/qims-22-483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/11/2022] [Indexed: 01/15/2023]
Abstract
Background Inferior clinical outcomes have been reported in patients with degenerative lumbar spondylolisthesis (DLS) accompanied by lumbar degenerative scoliosis, but little attention has been paid to its radiologic assessment or preoperative planning. The aim of this study was to analyze the effect of transforaminal lumbar interbody fusion on patients with DLS and lumbar degenerative scoliosis and explore the surgical aspects benefiting the restoration of lumbar degenerative scoliosis. Methods All patients with DLS and lumbar degenerative scoliosis undergoing single-level unilateral transforaminal lumbar interbody fusion surgery between July 1, 2015, and April 30, 2021, were screened in this retrospective cohort study. Clinical outcomes including visual analog scale (VAS), Oswestry disability index (ODI), and radiographic parameters of sagittal and coronal alignment, cage spatial locations, and angle of pedicle screw (parallel, cranial, and caudad angle) were assessed. Coronal asymmetry was demonstrated by the intervertebral height difference between the medial and lateral margins of indexed intersegmental space. The correlations between Δintervertebral height difference (postoperative intervertebral height difference-preoperative intervertebral height difference) and radiographic parameters and clinical outcomes were analyzed by univariable, multivariable, mediation, and correlation analyses. Significance was set at a bilateral P<0.05. Results A total of 57 included patients were followed up for a minimum of 1 year. Reduction of VAS, ODI, and improvement of radiographic parameters were found after surgery. The cranial angle of the lower pedicle screw positively correlated with Δintervertebral height difference restoration (b=0.54; standard error=0.11; P<0.001). Conclusions Transforaminal lumbar interbody fusion surgery appears to be an effective approach to improving the radiographic and clinical outcomes of patients with DLS and lumbar degenerative scoliosis. The cranial direction of the lower pedicle screws in single-level unilateral transforaminal lumbar interbody fusion surgery may be associated with a better postoperative restoration of lumbar degenerative scoliosis.
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Affiliation(s)
- Xuqiang Zhan
- Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xinhua Zhan
- Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jili Yu
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | | | - Fuping Li
- Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of Spine Surgery, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Xin Xi
- Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhili Zeng
- Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | | | - Yan Yu
- Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liming Cheng
- Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Jiang J, Hu J, Cai HP, Niu L, Zheng ML, Chen X, Zhang WZ. Radiographic analysis of dynamic lumbar motion during the five-repetition sit-to-stand test in degenerative lumbar spondylolisthesis. BMC Musculoskelet Disord 2022; 23:800. [PMID: 35996131 PMCID: PMC9394038 DOI: 10.1186/s12891-022-05761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background To investigate the mechanisms of low back pain triggered by the five-repetition sit-to-stand test (5R-STS test) in degenerative lumbar spondylolisthesis (DLS) from radiographic perspective, as well as to determine the most useful diagnostic modalities in the evaluation of segmental instability. Methods We retrospectively performed a study of 78 patients (23 men and 55 women) with symptomatic DLS at L4/5 in our institution between April 2020 and December 2021. Each patient was assessed by using the 5R-STS test and received a series of radiographs including the upright standing, normal sitting, standing flexion–extension radiographs, and supine sagittal MR images. Enrolled patients were divided into two groups based on the 5R-STS test score: severe group and mild group. Translational and angular motion was determined by comparing normal sitting radiograph (N) with upright standing radiograph (U) (Combined, NU), flexion/extension radiographs (FE) as well as normal sitting radiograph (N) with a supine sagittal MR image (sMR) (Combined, N-sMR). Results Overall, 78 patients were enrolled, and there were 31(39.7%) patients in group S and 47(60.3%) patients in group M, with an average age of 60.7 ± 8.4 years. The normal sitting radiograph demonstrated the maximum slip percentage (SP) and the highest kyphotic angle both in group S and group M. Compared with group M, group S revealed significantly higher SP in the normal sitting position (24.1 vs 19.6; p = 0.002). The lumbar slip angular in group S with a sitting position was significantly higher than that in group M (-5.2 vs -1.3; p < 0.001). All patients in group S had objective functional impairment (OFI) and 28 patients of them were diagnosed with lumbar instability by using the combination of normal sitting radiograph (N) and supine sagittal MR image (sMR) (Combined, N-sMR). Conclusion DLS patients with positive sign of the 5R-STS test is a distinct subgroup associated with lumbar instability. The modality of the combination of normal sitting radiograph (N) and supine sagittal MR image (sMR) had a significant advantage in terms of the ability to identify segmental instability.
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Affiliation(s)
- Jiang Jiang
- Department of Orthopedics, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, China
| | - Jun Hu
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Hai-Ping Cai
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lei Niu
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Meng-Long Zheng
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xi Chen
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China. .,, Hefei, China.
| | - Wen-Zhi Zhang
- Department of Orthopedics, The Affiliated Provincial Hospital of Anhui Medical University, Hefei, China. .,, Hefei, China.
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Zuckerman SL, Cerpa M, Lai CS, Lenke LG. Coronal Alignment in Adult Spinal Deformity Surgery: Definitions, Measurements, Treatment Algorithms, and Impact on Clinical Outcomes. Clin Spine Surg 2022; 35:196-203. [PMID: 33843764 DOI: 10.1097/bsd.0000000000001175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
The major focus of realignment in adult spinal deformity (ASD) surgery has been on the sagittal plane, and less emphasis has been given to the coronal plane. In light of this overlooked area within ASD surgery, we aimed to refocus the narrative on coronal alignment in ASD surgery. The objectives of the current narrative review were to (1) define coronal alignment and discuss existing measurements; (2) report the incidence and prevalence of coronal malalignment (CM); (3) discuss the impact of CM on clinical outcomes; and (4) describe our preferred treatment algorithm of surgical correction of CM in ASD.
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Affiliation(s)
- Scott L Zuckerman
- Department of Orthopedic Surgery, Columbia University Medical Center, The Och Spine Hospital at New York Presbyterian, New York, NY
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Dong S, Zhu Y, Yang H, Tang N, Huang G, Li J, Tian K. Evaluation of the Predictors for Unfavorable Clinical Outcomes of Degenerative Lumbar Spondylolisthesis After Lumbar Interbody Fusion Using Machine Learning. Front Public Health 2022; 10:835938. [PMID: 35309190 PMCID: PMC8927688 DOI: 10.3389/fpubh.2022.835938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background An increasing number of geriatric patients are suffering from degenerative lumbar spondylolisthesis (DLS) and need a lumbar interbody fusion (LIF) operation to alleviate the symptoms. Our study was performed aiming to determine the predictors that contributed to unfavorable clinical efficacy among patients with DLS after LIF according to the support vector machine (SVM) algorithm. Methods A total of 157 patients with single-segment DLS were recruited and performed LIF in our hospital from January 1, 2015 to October 1, 2020. Postoperative functional evaluation, including ODI and VAS were, performed, and endpoint events were defined as significant relief of symptom in the short term (2 weeks postoperatively) and long term (1 year postoperatively). General patient information and radiological data were selected and analyzed for statistical relationships with the endpoint events. The SVM method was used to establish the predictive model. Results Among the 157 consecutive patients, a postoperative unfavorable clinical outcome was reported in 26 patients (16.6%) for a short-term cohort and nine patients (5.7%) for a long-term cohort. Based on univariate and multivariate regression analysis, increased disc height (DH), enlarged facet angle (FA), and raised lateral listhesis (LLS) grade were confirmed as the risk factors that hindered patients' short-term functional recovery. Furthermore, long-term functional recovery was significantly associated with DH alone. In combination with the SVM method, a prediction model with consistent and superior predictive performance was achieved with average and maximum areas under the receiver operating characteristic curve (AUC) of 0.88 and 0.96 in the short-term cohort, and 0.78 and 0.82 in the long-term cohort. The classification results of the discriminant analysis were demonstrated by the confusion matrix. Conclusions The proposed SVM model indicated that DH, FA, and LLS were statistically associated with a clinical outcome of DLS. These results may provide optimized clinical strategy for treatment of DLS.
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Affiliation(s)
- Shengtao Dong
- Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yinghui Zhu
- Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
- Department of Orthopedics, Dalian No. 3 People's Hospital, Dalian, China
| | - Hua Yang
- Department of Otolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ningyu Tang
- Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Guangyi Huang
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jie Li
- Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
- *Correspondence: Jie Li
| | - Kang Tian
- Department of Bone and Joint, First Affiliated Hospital, Dalian Medical University, Dalian, China
- Kang Tian
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Wang XW, Chen X, Fu Y, Chen X, Zhang F, Cai HP, Ge C, Zhang WZ. Analysis of lumbar lateral instability on upright left and right bending radiographs in symptomatic patients with degenerative lumbar spondylolisthesis. BMC Musculoskelet Disord 2022; 23:59. [PMID: 35039039 PMCID: PMC8764856 DOI: 10.1186/s12891-022-05017-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 01/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background To evaluate lumbar mobility in various positions using upright left and right bending radiographs in patients with degenerative lumbar spondylolisthesis (DLS), as well as to assess the impact of lateral instability on patient-reported outcomes. Methods This study retrospectively reviewed a consecutive series of patients with DLS between January 2019 and October 2020. The enrolled patients were divided into two groups: the lateral instability group (group L) and non-lateral instability group (group NL). Translational and angular motion in both sagittal and coronal planes and patient-reported outcomes were compared between the two groups. Results There were 104 (59.8%) patients in group L and 70 (40.2%) patients in group NL, with an average age of 60.6 ± 7.8 years. Patients with a right bending posture in group L had a higher slip percentage (14.2 ± 7.4% vs 9.2 ± 3.2%, p = 0.01) and slip angle (6.3 ± 1.5° vs 2.2 ± 0.8°, p = 0.021). Compared with group NL, group L demonstrated significantly larger angular motion in the coronal plane (2.4 ± 1.3° vs 1.0 ± 0.7°, p = 0.008). Patients with lateral instability had worse preoperative back pain (6.1 ± 1.6 vs 2.7 ± 1.9, p = 0.01) and Oswestry Disability Index (ODI) scores (37.7 ± 5.5 vs 25.6 ± 2.6, p = 0.002). In terms of pain characteristics, group L was characterized by pain when getting out of a car, when rising from a chair, and when climbing stairs (all p values < 0.05). Conclusion Lumbar lateral instability, that is, increased mobility in the coronal plane on lateral bending radiographs, translational and/or angular, correlates to more pronounced patient related symptoms in degenerative L4–5 spondylolisthesis. The existence of lumbar lateral instability leads to worse impacts on patient-reported outcomes when patients change their positions including getting out of a car, rising from a chair, and climbing stairs.
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Affiliation(s)
- Xin-Wen Wang
- Department of Orthopedics, Spine Center, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, No. 17, Lujiang Road, Hefei, 230001, China
| | - Xi Chen
- Department of Orthopedics, Spine Center, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, No. 17, Lujiang Road, Hefei, 230001, China
| | - Yang Fu
- Department of Orthopedics, Spine Center, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, No. 17, Lujiang Road, Hefei, 230001, China
| | - Xiao Chen
- Department of Orthopedics, Spine Center, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, No. 17, Lujiang Road, Hefei, 230001, China
| | - Feng Zhang
- Department of Orthopedics, Spine Center, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, No. 17, Lujiang Road, Hefei, 230001, China
| | - Hai-Ping Cai
- Department of Orthopedics, Spine Center, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, No. 17, Lujiang Road, Hefei, 230001, China
| | - Chang Ge
- Department of Orthopedics, Spine Center, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, No. 17, Lujiang Road, Hefei, 230001, China
| | - Wen-Zhi Zhang
- Department of Orthopedics, Spine Center, The First Affiliated Hospital of USTC: Anhui Provincial Hospital, No. 17, Lujiang Road, Hefei, 230001, China.
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Jacob KC, Patel MR, Collins AP, Ribot MA, Pawlowski H, Prabhu MC, Vanjani NN, Singh K. The Effect of the Severity of Preoperative Disability on Patient-Reported Outcomes and Patient Satisfaction Following Minimally Invasive Transforaminal Lumbar Interbody Fusion. World Neurosurg 2021; 159:e334-e346. [PMID: 34942388 DOI: 10.1016/j.wneu.2021.12.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/14/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare patient-reported outcomes (PROMs), satisfaction, and minimum clinically important difference (MCID) achievement following minimally invasive transforaminal lumbar interbody fusion stratified by preoperative disability. METHODS Minimally invasive transforaminal lumbar interbody fusions were grouped by preoperative Oswestry Disability Index (ODI) score: ODI <41 or ODI ≥41. PROMs administered pre/postoperatively included Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF), visual analog scale (VAS) back/leg, ODI, and 12-Item Short-Form Physical Composite Score (SF-12 PCS)/12-Item Short-Form Mental Composite Score (SF-12 MCS). Satisfaction scores were collected for VAS back/leg and ODI. Coarsened exact match controlled for differences between cohorts. T tests compared mean PROMs and postoperative improvement/satisfaction between cohorts. Simple logistic regression compared MCID achievement. RESULTS After coarsened exact matching, there were 118 patients in the ODI ≤41 and 377 patients in the ODI >41 cohort. The ODI >41 cohort saw greater postoperative inpatient VAS pain score and narcotic consumption on days 0/1 (P < 0.018, all). PROMs differed between cohorts: PROMIS-PF, SF-12 PCS, ODI, VAS back/leg at all postoperative time points and SF-12 MCS at 6 weeks/12 weeks/6 months/1 year (P < 0.045, all). Patients in the ODI >41 cohort demonstrated greater proportion achieving MCID for ODI at all postoperative time points and for SF-12 MCS 6-week/12-week/6-month/1-year (P < 0.040, all). The ODI ≤41 cohort demonstrated greater MCID achievement for overall PROMIS-PF and SF-12 PCS 6 months (P < 0.047, all). Postoperative satisfaction was greater in the ODI ≤41 cohort for VAS leg 6 weeks/12 weeks, VAS back 6 weeks/12 weeks, and ODI all postoperative time points (P < 0.048, all). CONCLUSIONS Preoperative disability associated with worse postoperative PROMs and patient satisfaction for disability, back/leg pain at multiple time points. MCID achievement rates across cohorts were similar for most PROMs at most postoperative time points. Patients with severe disability may have unrealistic expectations for surgical benefits, influencing corresponding postoperative satisfaction.
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Affiliation(s)
- Kevin C Jacob
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Madhav R Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Andrew P Collins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Max A Ribot
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Hanna Pawlowski
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael C Prabhu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nisheka N Vanjani
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
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Ohyama S, Aoki Y, Inoue M, Kubota G, Watanabe A, Nakajima T, Sato Y, Takahashi H, Nakajima A, Saito J, Eguchi Y, Orita S, Inage K, Shiga Y, Nakagawa K, Ohtori S. Influence of Preoperative Difference in Lumbar Lordosis Between the Standing and Supine Positions on Clinical Outcomes After Single-level Transforaminal Lumbar Interbody Fusion: Minimum 2-year Follow-up. Spine (Phila Pa 1976) 2021; 46:1070-1080. [PMID: 33492084 DOI: 10.1097/brs.0000000000003955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to investigate whether a preoperative difference in lumbar lordosis (D-LL) between the standing and supine positions is associated with clinical outcomes after transforaminal lumbar interbody fusion (TLIF). SUMMARY OF BACKGROUND DATA Several factors have been reported to be associated with surgical outcomes after TLIF. However, the association between preoperative D-LL and clinical outcomes after TLIF is unknown. METHODS We enrolled 45 lumbar degenerative disease patients (mean age: 65.7 ± 11.3 years old; 24 males) treated with single-level TLIF. Surgical outcomes were assessed using Oswestry disability index, visual analog scale (VAS; low back pain [LBP], lower-extremity pain, numbness, LBP in motion, in standing, and in sitting), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, Japanese Orthopaedic Association score for intermittent claudication (JOA score), and Nakai's scoring system. The preoperative D-LL between the standing radiograph and computed tomography (CT) in the supine position was defined as LL in supine CT-standing radiograph. Patients were divided into two groups according to D-LL value (D-LL >-4°, and D-LL ≤-4°). Clinical outcomes were compared between the groups, and correlations between preoperative D-LL and clinical outcomes were analyzed. RESULTS There were no significant differences in preoperative clinical parameters between the two groups. Postoperative VASs for lower extremity pain, numbness, LBP in standing, and JOA score in D-LL >-4° group were significantly worse than in the D-LL ≤-4° group (P < 0.05). Preoperative D-LL showed a weak correlation with postoperative lower extremity pain and numbness (P < 0.05). CONCLUSION This study revealed that lumbar degenerative disease patients, who have greater preoperative kyphotic lumbar alignment in the standing versus supine position, tend to have postoperative residual symptoms after TLIF. A preoperative comparison of lateral radiographs between the standing and supine positions is useful to predict patients' postoperative residual symptoms.Level of Evidence: 3.
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Affiliation(s)
- Shuhei Ohyama
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Go Kubota
- Department of Orthopaedic Surgery, Sawara Prefectural Hospital, Katori, Chiba, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Takayuki Nakajima
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Yusuke Sato
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Hiroshi Takahashi
- Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Arata Nakajima
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Junya Saito
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
| | - Koichi Nakagawa
- Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba-city, Chiba, Japan
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Pan W, Zhao JL, Xu J, Zhang M, Fang T, Yan J, Wang XH, Zhou Q. Lumbar alignment and patient-reported outcomes after single-level transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with and without local coronal imbalance. J Neurosurg Spine 2021; 34:464-470. [PMID: 33276333 DOI: 10.3171/2020.7.spine20703] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the preoperative radiographic features of degenerative lumbar spondylolisthesis (DLS) with and without local coronal imbalance (LCI) and to investigate the surgical outcomes of transforaminal lumbar interbody fusion (TLIF) in the treatment of DLS with LCI at the spondylolisthesis level. DLS with scoliotic disc wedging and/or lateral listhesis at the same involved segment, as well as LCI, constitutes a distinct subgroup. However, previous studies concerning surgical outcomes focused mainly on sagittal profiles. There is a paucity of valid data regarding lumbar coronal alignment and patient-reported outcomes (PROs) after surgery in DLS with LCI. METHODS The authors reviewed consecutive patients who received TLIF for L4/5 DLS between 2009 and 2018. Patients were assigned to the LCI and non-LCI groups based on preoperative radiographs. Demographics, radiographic parameters related to both sagittal and coronal alignment, and PROs were compared between the 2 groups. RESULTS There were 21 patients in the LCI and 80 in the non-LCI group. Compared with the non-LCI group, the LCI group was characterized by lower preoperative lumbar lordosis on sagittal alignment (38.3° vs 43.7°, p < 0.05), higher lumbar Cobb angle on coronal alignment (12.4° vs 5.1°, p < 0.05), and worse lumbar coronal balance (18.5 mm vs 6.8 mm, p < 0.05). After surgery, lumbar alignment in the sagittal and coronal planes was significantly improved in the LCI group, whereas no significant changes occurred in the non-LCI group. Scores on the preoperative Oswestry Disability Index and the visual analog scale for back pain and leg pain scores were significantly higher in the LCI group, whereas no differences were found between the 2 groups in the postoperative evaluation (p > 0.05). CONCLUSIONS DLS with LCI constitutes a distinct subgroup characterized by coronal malalignment and loss of whole lumbar lordosis, which may result in worse PROs. The TLIF procedure allows the reconstruction of the coronal and sagittal lumbar profile and achievement of satisfactory PROs.
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Redaelli A, Langella F, Dziubak M, Cecchinato R, Damilano M, Peretti G, Berjano P, Lamartina C. Useful and innovative methods for the treatment of postoperative coronal malalignment in adult scoliosis: the "kickstand rod" and "tie rod" procedures. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:849-859. [PMID: 31907658 DOI: 10.1007/s00586-019-06285-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/21/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Surgical technique description and case series. OBJECTIVE To describe the use of two techniques for the correction of postoperative coronal imbalance after surgical treatment for adult spine deformity (ASD). Sagittal and coronal spinal malalignments are often present in patients with ASD or in patients who have undergone spine surgery. Surgical correction of coronal imbalance is insufficiently investigated, and the literature provides a limited spectrum of surgical options when compared to sagittal imbalance. Nevertheless, this deformity can compromise the surgical outcome and can increase the risk of hardware failure. METHODS The kickstand (KR) and tie rod (TR) techniques utilize an accessory rod, linking the previous instrumentation to an independent iliac screw. After a proper release of the lumbar spine with anterior release or posterior osteotomies, the KR technique pushes with distraction on the concave side, whereas the TR technique pulls with compression on the convex side. Four patients (mean age, 64 years; SD 5.7) affected by severe postoperative coronal imbalance were treated. C7-PL ranges from 39 to 76 mm. The mean preoperative ODI was 70/100 (range from 55 to 82). All patients had previous spinopelvic fixation as a consequence of corrective surgery for adult spine deformity. The patients were surgically treated with the addition of supplementary rods connected to the ilium. The rods were used in the concavity or convexity of the deformity functioning as "kickstand" or "tie" or a combination of both. RESULTS The mean surgical correction of C7-PL was 35 mm (range from 20 to 52 mm). In particular, the mean correction for kickstand rod technique was 26 mm and for tie rod technique was 43 mm. All of the patients improved their preoperative disability, and mean ODI was 30/100 (range from 10 to 60) at median 19-month follow-up. All postoperative imaging showed implants were in proper position without hardware failure. All of the patients treated demonstrated an immediate postoperative improvement in terms of coronal displacement of the spine. No complications were observed. At 1-year follow-up, all of the patients remained satisfactory in terms of clinical outcomes. CONCLUSION The kickstand and tie rod techniques are effective in the treatment of postoperative coronal malalignment. Further studies are needed to confirm these findings. LEVEL OF EVIDENCE V: Case report. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Andrea Redaelli
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy
| | - Francesco Langella
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy
| | - Michal Dziubak
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Riccardo Cecchinato
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy
| | - Marco Damilano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy
| | - Giuseppe Peretti
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Pedro Berjano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy.
| | - Claudio Lamartina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, CAP 20161, Milan, Italy
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Praeger AJ, Wang YYI, Goldschlager T. Intraoperatively predicting postoperative sagittal balance using intraoperative X-rays. J Clin Neurosci 2019; 63:48-54. [PMID: 30827877 DOI: 10.1016/j.jocn.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/15/2019] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
This study aimed to assess the correlation of sagittal balance parameters measured intraoperatively, against the gold standard post-operative standing full spine X-ray. A secondary aim was to create a predictive algorithm, that could be used intraoperatively to predict the post-operative balance. 49 patients, who underwent thoracolumbar spinal fusion over a 12-month period were included in this study. Standing full-spine X-rays were obtained both pre and post-surgical fixation. Parallel intraoperative X-rays were taken with the c-arm centred on femoral heads, operative level, S1 and L1. The sagittal parameters pelvic incidence (PI), lumbar lordosis (LL), spino-pelvic mismatch (PI-LL), and sagittal vertical axis were then measured and the correlations statistically analysed. For prone positioned patients the mean LL was 59.9° ± 10.6° intraoperatively (post-fixation) and post-operatively 55.4° ± 10.9° with a mean difference of -4.5° ± 6.1° (p-value < 0.001). For laterally positioned patients the mean LL was 50.9° ± 8.6° intraoperatively and 53.1° ± 10.1° postoperatively for a mean difference of -2.3° ± 6.5° (p-value = 0.117). The linear regression analysis resulted in a predictive algorithm that can be utilised intraoperatively to predict the post-operative standing pelvic mismatch for prone positioned patients. In conclusion, measuring spino-pelvic parameters of sagittal balance intraoperatively can be used to estimate postoperative standing full spine x-ray result. Specifically, in the prone position, the surgeon should aim for intraoperative lordosis that is 4.5° more than the desired post-operative lordosis. The predictive formula provides a direct method to quickly calculate the post-operative pelvic mismatch intraoperatively.
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Affiliation(s)
- Adrian J Praeger
- Department of Neurosurgery, Monash Health, Melbourne, Australia.
| | - Yi Yuen Ian Wang
- Department of Neurosurgery, St Vincent's Hospital, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
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Salem KMI, Eranki AP, Paquette S, Boyd M, Street J, Kwon BK, Fisher CG, Dvorak MF. Do intraoperative radiographs predict final lumbar sagittal alignment following single-level transforaminal lumbar interbody fusion? J Neurosurg Spine 2018; 28:486-491. [DOI: 10.3171/2017.8.spine161231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe study aimed to determine if the intraoperative segmental lordosis (as calculated on a cross-table lateral radiograph following a single-level transforaminal lumbar interbody fusion [TLIF] for degenerative spondylolisthesis/low-grade isthmic spondylolisthesis) is maintained at discharge and at 6 months postsurgery.METHODSThe authors reviewed images and medical records of patients ≥ 16 years of age with a diagnosis of an isolated single-level, low-grade spondylolisthesis (degenerative or isthmic) with symptomatic spinal stenosis treated between January 2008 and April 2014. Age, sex, surgical level, surgical approach, and facetectomy (unilateral vs bilateral) were recorded. Upright standardized preoperative, early, and 6-month postoperative radiographs, as well as intraoperative lateral radiographs, were analyzed for the pelvic incidence, segmental lumbar lordosis (SLL) at the TILF level, and total LL (TLL). In addition, the anteroposterior position of the cage in the disc space was documented. Data are presented as the mean ± SD; a p value < 0.05 was considered significant.RESULTSEighty-four patients were included in the study. The mean age of patients was 56.8 ± 13.7 years, and 46 patients (55%) were men. The mean pelvic incidence was 59.7° ± 11.9°, and a posterior midline approach was used in 47 cases (56%). All TLIF procedures were single level using a bullet-shaped cage. A bilateral facetectomy was performed in 17 patients (20.2%), and 89.3% of procedures were done at the L4–5 and L5–S1 segments. SLL significantly improved intraoperatively from 15.8° ± 7.5° to 20.9° ± 7.7°, but the correction was lost after ambulation. Compared with preoperative values, at 6 months the change in SLL was modest at 1.8° ± 6.7° (p = 0.025), whereas TLL increased by 4.3° ± 9.6° (p < 0.001). The anteroposterior position of the cage, approach, level of surgery, and use of a bilateral facetectomy did not significantly affect postoperative LL.CONCLUSIONSFollowing a single-level TLIF procedure using a bullet-shaped cage, the intraoperative improvement in SLL is largely lost after ambulation. The improvement in TLL over time is probably due to the decompression part of the procedure. The approach, level of surgery, bilateral facetectomy, and position of the cage do not seem to have a significant effect on LL achieved postoperatively.
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Omidi-Kashani F, Jalilian R, Golhasani-Keshtan F. Effect of interbody fusion cage on clinical and radiological outcome of surgery in L4-L5 lumbar degenerative spondylolisthesis. JOURNAL OF SPINE SURGERY 2018; 4:109-114. [PMID: 29732430 DOI: 10.21037/jss.2018.03.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Lumbar degenerative spondylolisthesis (LDS) is a degenerative slippage of a lumbar vertebra relative to the adjacent vertebra below that can be clinically symptomatic. We aim to compare radiological and clinical outcome of surgery in L4-L5 LDS with or without applying the interbody fusion cage. Methods We studied 60 patients (mean age, 51.3±13.2 years; follow-up, 53.3±14.6 months) with L4-L5 LDS who had been treated by decompression, pedicle screw and rod instrumentation associated with posterolateral fusion (PLF) without and with transforaminal lumbar interbody fusion (TLIF) in equally divided groups A and B, respectively. Intraoperative parameters were recorded and outcome assessment carried out by visual analog scale (VAS), Oswestry Disability Index questionnaire (ODI), subjective satisfaction, radiologic union, and loss of reduction. We judged the differences by t-test and cross-tab. Results Using an interbody fusion cage was associated with a significant increase in intraoperative blood loss, operative time, and instrument cost. Improvement in VAS and ODI were significant but comparable. Satisfaction rate was higher in group A (P=0.52). Fusion rate and loss of correction were more favorable in group B but these differences were not significant. Conclusions In the surgical treatment of the patients with L4-L5 LDS, interbody fusion cage probably does not significantly improve the radiologic and clinical outcomes and may also be associated with more complication and morbidity.
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Affiliation(s)
- Farzad Omidi-Kashani
- Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Jalilian
- Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farideh Golhasani-Keshtan
- Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Takahashi T, Hanakita J, Ohtake Y, Funakoshi Y, Oichi Y, Kawaoka T, Watanabe M. Current Status of Lumbar Interbody Fusion for Degenerative Spondylolisthesis. Neurol Med Chir (Tokyo) 2016; 56:476-84. [PMID: 27169496 PMCID: PMC4987447 DOI: 10.2176/nmc.ra.2015-0350] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Instrumented lumbar fusion can provide immediate stability and assist in satisfactory arthrodesis in patients who have pain or instability of the lumbar spine. Lumbar adjunctive fusion with decompression is often a good procedure for surgical management of degenerative spondylolisthesis (DS). Among various lumbar fusion techniques, lumbar interbody fusion (LIF) has an advantage in that it maintains favorable lumbar alignment and provides successful fusion with the added effect of indirect decompression. This technique has been widely used and represents an advancement in spinal instrumentation, although the rationale and optimal type of LIF for DS remains controversial. We evaluated the current status and role of LIF in DS treatment, mainly as a means to augment instrumentation. We addressed the basic concept of LIF, its indications, and various types including minimally invasive techniques. It also has acceptable biomechanical features, and offers reconstruction with ideal lumbar alignment. Postsurgical adverse events related to each LIF technique are also addressed.
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