Influence of pelvic incidence-lumbar lordosis mismatch on surgical outcomes of short-segment transforaminal lumbar interbody fusion

BMC Musculoskeletal Disorders

Koichi Nakagawa⁴  Yawara Eguchi¹  Sumihisa Orita²  Makoto Takazawa³  Takayuki Nakajima³  Atsuya Watanabe³  Seiji Ohtori²  Kazuhisa Takahashi²  Masahiko Saito⁴  Fumiaki Terajima⁴  Masato Sonobe⁴  Hiroshi Takahashi⁴  Arata Nakajima⁴  Yasuchika Aoki³ 

[1] Department of Orthopaedic Surgery, National Hospital Organization Shimoshizu Hospital, 934-5Shikawatashi, Yotsukaido 284-0003, Chiba, Japan;Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuoku, Chiba city 260-8677, Chiba, Japan;Department of General Medical Science, Graduate School of Medicine, Chiba University, 1-8-1 Inohana,Chuo-ku, Chiba city 260-8670, Chiba, Japan;Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura 285-8741, Chiba, Japan

关键词: Lumbar interbody fusion;    Lumbar lordosis;    Pelvic incidence;    Flat-back;    Spinopelvic;    Sagittal alignment;   

Others  :  1227670
DOI  :  10.1186/s12891-015-0676-1

 received in 2015-03-26, accepted in 2015-08-12,  发布年份 2015

【 摘 要 】

Background

The importance of pelvic incidence-lumbar lordosis (PI-LL: PI minus LL) mismatch is emphasized in long-segment fusion for adult spinal deformity; however, there are few studies evaluating the influence of PI-LL on surgical outcomes after short-segment fusion. In this study, we have examined the effects of PI-LL mismatch on surgical outcomes of short-segment lumbar intervertebral fusion for lumbar degenerative diseases.

Methods

Patients with lumbar degenerative disease treated by short-segment (1 or 2 levels) transforaminal lumbar interbody fusion were divided into Group A (PI-LL ≤ 10°: n = 22) and Group B (PI-LL ≥ 11°: n = 30). Pre-and post-operative patient symptoms were assessed by the visual analogue scale (VAS: scores 0-100 mm; for LBP, lower-extremity pain, and lower-extremity numbness), a detailed VAS for LBP while in motion, standing, and sitting, and the Oswestry disability index (ODI). Surgical outcomes were evaluated by the Nakai score (3 = excellent to 0 = poor. Post-operative data were acquired for at least one year following surgery and were compared between the two groups. Multiple regression analyses were used to evaluate the relative influence of PI-LL on each pre-and post-operative parameter (VAS, detailed VAS and ODI) adjusted for age, sex, fusion levels, body mass index, presence of scoliosis, diabetes mellitus and depression.

Results

The surgical outcomes in Group A were significantly better than those of Group B. Group A showed better post-operative VAS scores for LBP, particularly LBP while standing (11.9 vs. 25.8). The results of the multivariate analyses showed no significant correlation between PI-LL and pre-operative symptoms, but did show a significant correlation between PI-LL and the post-operative VAS score for LBP, lower extremity pain, and numbness.

Conclusions

This study is the first to find that PI-LL mismatch influences post-operative residual symptoms, such as LBP, lower extremity pain and numbness. Among the three types of LBP examined in the detailed VAS, LBP while standing was most strongly related to PI-LL mismatch. The importance of maintaining spinopelvic alignment is emphasized, particularly when treating patients with adult spinal deformity using long-segment fusion surgery. However, our results indicate that surgeons should pay attention to sagittal spinopelvic alignment and avoid post-operative PI-LL mismatch even when treating patients with short-segment lumbar interbody fusion.

【 授权许可】

   
2015 Aoki et al.

【 参考文献 】

• [1]Harms J, Rolinger H. A one-stage procedure in operative treatment of spondylolisthesis : dorsal traction-reposition and anterior fusion. Z Orthop Ihre Grenzgeb. 1982; 120:343-7.
• [2]Taneichi H, Suda K, Kajino T, Matsumura A, Moridaira H, Kaneda K. Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period. J Neurosurg Spine. 2006; 4(3):198-205.
• [3]Lauber S, Schulte TL, Liljenqvist U, Halm H, Hackenberg L. Clinical and radiologic 2-4-year results of transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Spine. 2006; 31(15):1693-8.
• [4]Park P, Foley KT. Minimally invasive transforaminal lumbar interbody fusion with reduction of spondylolisthesis: technique and outcomes after a minimum of 2 years’ follow-up. Neurosurg Focus. 2008; 25(2):E16.
• [5]Aoki Y, Yamagata M, Ikeda Y, Nakajima F, Ohtori S, Nakagawa K et al.. A prospective randomized controlled study comparing transforaminal lumbar interbody fusion techniques for degenerative spondylolisthesis: unilateral pedicle screw and 1 cage versus bilateral pedicle screws and 2 cages. J Neurosurg Spine. 2012; 17(2):153-9.
• [6]Kostuik JP, Maurais GR, Richardson WJ, Okajima Y. Combined single stage anterior and posterior osteotomy for correction of iatrogenic lumbar kyphosis. Spine. 1988; 13(3):257-66.
• [7]La Grone MO. Loss of lumbar lordosis. A complication of spinal fusion for scoliosis. Orthop Clin North Am. 1988; 19(2):383-93.
• [8]Schwab F, Patel A, Ungar B, Farcy JP, Lafage V. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine. 2010; 35(25):2224-31.
• [9]Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS et al.. Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine. 2013; 38(13):E803-12.
• [10]Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D et al.. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine. 2012; 37(12):1077-82.
• [11]Nakai O, Ookawa A, Yamaura I. Long-term roentgenographic and functional changes in patients who were treated with wide fenestration for central lumbar stenosis. J Bone Joint Surg Am. 1991; 73(8):1184-91.
• [12]Aoki Y, Sugiura S, Nakagawa K, Nakajima A, Takahashi H, Ohtori S et al.. Evaluation of nonspecific low back pain using a new detailed visual analogue scale for patients in motion, standing, and sitting: characterizing nonspecific low back pain in elderly patients. Pain Res Treat. 2012; 2012:680496.
• [13]Sakaura H, Yamashita T, Miwa T, Ohzono K, Ohwada T. Outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis. J Neurosurg Spine. 2013; 19-1:90-4.
• [14]Senteler M, Weisse B, Snedeker JG, Rothenfluh DA. Pelvic incidence-lumbar lordosis mismatch results in increased segmental joint loads in the unfused and fused lumbar spine. Eur Spine J. 2014; 23(7):1384-93.
• [15]Rothenfluh DA, Mueller DA, Rothenfluh E, Min K. Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion. Eur Spine J. 2014; 24(6):1251-8.
• [16]Reames DL, Kasliwal MK, Smith JS, Hamilton DK, Arlet V, Shaffrey CI. Time to development, clinical and radiographic characteristics, and management of proximal junctional kyphosis following adult thoracolumbar instrumented fusion for spinal deformity. J Spinal Disord Tech. 2015; 28(2):E106-14.
• [17]Smith JS, Shaffrey E, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ et al.. Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine. 2014; 21(6):994-1003.
• [18]Kim MK, Lee SH, Kim ES, Eoh W, Chung SS, Lee CS. The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: a pilot study. BMC Musculoskelet Disord. 2011; 12:69. BioMed Central Full Text
• [19]Lazennec JY, Ramare S, Arafati N, Laudet CG, Gorin M, Roger B et al.. Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J. 2000; 9-1:47-55.
• [20]Le Huec JC, Faundez A, Dominguez D, Hoffmeyer P, Aunoble S. Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop. 2015; 39-1:87-95.
• [21]Hioki A, Miyamoto K, Kodama H, Hosoe H, Nishimoto H, Sakaeda H et al.. Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis. Spine J. 2005; 5-6:600-7.
• [22]Kim JK, Moon BG, Kim DR, Kim JS. Postoperative flat back: contribution of posterior accessed lumbar interbody fusion and spinopelvic parameters. J Korean Neurosurg Soc. 2014; 56(4):315-22.
• [23]Alimi M, Hofstetter CP, Cong GT, Tsiouris AJ, James AR, Paulo D et al.. Radiological and clinical outcomes following extreme lateral interbody fusion. J Neurosurg Spine. 2014; 20(6):623-35.
• [24]Tohmeh A, Khorsand D, Watson B, Zielinski X. Radiographic and clinical evaluation of XLIF: effects of cage and instrumentation type with a minimum of 1 year follow-up. Spine. 2014; 39(26):E1582-91.
• [25]Malham GM, Ellis NJ, Parker RM, Blecher CM, White R, Goss B, et al. Maintenance of segmental lordosis and disc height in standalone and instrumented extreme lateral interbody fusion (XLIF). J Spinal Disord Tech. 2014; Mar 24. [Epub ahead of print]