Adequate Restoration of Disc Height and Segmental Lordosis by Lumbar Interbody Fusion Decreases Adjacent Segment Degeneration

Tian, Haijun; Wu, Ai-Min; Guo, Mingke; Zhang, Kai; Chen, Chen; Li, Xunlin; Cheng, Xiaofei; Zhou, Ting; Murray, Samuel S.; Sun, Xiaojiang; Zhao, Jie

doi:10.1016/j.wneu.2018.07.075

Cited by 39 publications

(23 citation statements)

References 38 publications

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“…However, significantly better postoperative height restoration was seen in the control group than in the ASD group. Height restoration of the fused level is an important factor associated with the occurrence of ASD [34] and is another corresponding factor with the here found results.…”

Section: Discussionsupporting

confidence: 87%

Patient-specific statistical shape modeling for optimal spinal sagittal alignment in lumbar spinal fusion

et al. 2021

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Purpose The present study compared patients developing ASD after L4/5 spinal fusion with a control group using a patient-specific statistical shape model (SSM) to find alignment-differences between the groups. Methods This study included patients who had undergone spinal fusion at L4/5 and either remained asymptomatic (control group; n = 25, follow-up of > 4 years) or required revision surgery for epifusional ASD (n = 22). Landmarks on preoperative and postoperative lateral radiographs were annotated, and the optimal spinal sagittal alignment was calculated for each patient. The two-dimensional distance from the SSM-calculated optimum to the actual positions before and after fusion surgery was compared. Results Postoperatively, the additive mean distance from the SSM-calculated optimum was 86.8 mm in the ASD group and 67.7 mm in the control group (p = 0.119). Greater differences were observed between the groups with a larger distance to the ideal in patients with ASD at more cranial levels. Significant difference between the groups was seen postoperatively in the vertical distance of the operated segment L4. The patients with ASD (5.69 ± 3.0 mm) had a significant greater distance from the SSM as the control group (3.58 ± 3.5 mm, p = 0.034). Conclusion Patients with ASD requiring revision after lumbar spinal fusion have greater differences from the optimal spinal sagittal alignment as an asymptomatic control group calculated by patient-specific statistical shape modeling. Further research might help to understand the value of SSM, in conjunction with already established indexes, for preoperative planning with the aim of reducing the risk of ASD. Level of evidence I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding

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Section: Discussionsupporting

confidence: 87%

Patient-specific statistical shape modeling for optimal spinal sagittal alignment in lumbar spinal fusion

et al. 2021

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“…The smaller damage caused by MIS-TLIF to the surrounding soft tissue and the recovery of postoperative spinal stability may contribute to this difference. However, recent studies suggest that SL affects the overall sagittal balance of the spine, adequate restoration of intervertebral disc height and SL is beneficial in reducing the degeneration of adjacent segments [36]. Poor restoration of intervertebral parameters by MIS-TLIF reported in our study influenced the sagittal balance and longterm structural stability.…”

Section: Discussioncontrasting

confidence: 51%

Distinct fusion intersegmental parameters regarding local sagittal balance provide similar clinical outcomes: a comparative study of minimally invasive versus open transforaminal lumbar interbody fusion

et al. 2020

BMC Surg

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Background: Most contemporary studies suggested that intersegmental parameters including disc height and local lordosis contribute to the sagittal balance of fused lumbar. Although similar clinical outcomes following MIS-and Open-TLIF were reported essentially at the early postoperative time, the comparison of local balance variables after these two different techniques was lack. The radiological differences maybe not relevant to the postoperative efficacy at an earlier post-operation stage. But during the long-term follow-up, the complications with regards to the sagittal imbalance might occur due to the distinct biomechanical properties of fusion level after MIS-and Open-TLIF. Methods: The patients who underwent a single-level MIS-and Open-TLIF were reviewed retrospectively. The anterior disc height (ADH), posterior disc height (PDH), and segmental lordosis (SL) of the fusion segment were measured using recognition technical fluoroscopy. The mean disc height (MDH) was calculated by (ADH + PDH)/2. The relative DH was normalized by the anterior height of the upper vertebrae. The body mass index (BMI), the pain score of low back and leg visual analogue scale (VAS), Oswestry disability index (ODI), estimated blood loss, and hospital stay length was collected.

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“…The relative cage subsidence may decrease the disc height restoration and segmental lordosis (24,25). Inadequate restoration of disc height and segmental lordosis plays an important role in ASD (especially disc degeneration) (26)(27)(28)(29). Yang and Kim found that when the intervertebral space's height decreased, the normal facet joint would bear 3-25% more vertical stress (30), which may accelerate AFD.…”

Section: Discussionmentioning

confidence: 99%

Do the positioning variables of the cage contribute to adjacent facet joint degeneration? Radiological and clinical analysis following intervertebral fusion

Li¹,

Zhan²,

Xi³

et al. 2021

Ann Transl Med

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Background: Compared to other risk factors, adjacent facet joint degeneration (AFD) is the main contributor to adjacent segment disease (ASD). The interbody cage may be a potential indirect risk of AFD.This study investigated the correlations among the lumbar sagittal balance parameters, the inter-body cage's intraoperative positioning variables, and adjacent facet joint degeneration following the transforaminal lumbar interbody fusion (TLIF) technique.Methods: Patients who accepted single-level TLIF for symptomatic lumbar degenerative disease and were followed up for at least six months were enrolled in this study. According to the inclusive and exclusive criteria, 93 patients were included (44 males and 49 females). X-ray and computed tomography (CT) images were obtained before and six months after surgery. The vertebral contour and the center of the marker mass in the cage were calculated using a geometric algorithm. Orthopedic surgeons measured the disc height, lordosis angle, and facet joint degeneration. Patient-reported outcomes, including the Oswestry Disability Index (ODI) and the visual analog scale (VAS), were used to assess the clinical outcomes. The Student's t-test, Wilcoxon rank-sum test, and Chi-square test were used for the statistical analyses. Results:The average age was 53.7 years old (range, 27-84 years). The average functional disability outcome assessed by the ODI was 61.2, and the average back and leg pain assessed by the VAS was 6.2 and 6.9, respectively. The patients were categorized into a normal group and an abnormal (AFD) group according to whether the facet joint degeneration was aggravated. The abnormal group had a higher back pain VAS score (P=0.031) and lower sagittal vertical position (P=0.027). The other parameters were similar at baseline (P>0.05). The cage's sagittal vertical position decreased significantly with AFD aggravation (OR, 0.737; 95% CI, 0.561-0.969). Conclusions:In patients with AFD aggravation, the preoperative VAS and postoperative ODI scores were significantly higher. The cage position parameters were related to AFD. A lower cage center was associated with a greater incidence of AFD.

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Adequate Restoration of Disc Height and Segmental Lordosis by Lumbar Interbody Fusion Decreases Adjacent Segment Degeneration

Cited by 39 publications

References 38 publications

Patient-specific statistical shape modeling for optimal spinal sagittal alignment in lumbar spinal fusion

Patient-specific statistical shape modeling for optimal spinal sagittal alignment in lumbar spinal fusion

Distinct fusion intersegmental parameters regarding local sagittal balance provide similar clinical outcomes: a comparative study of minimally invasive versus open transforaminal lumbar interbody fusion

Do the positioning variables of the cage contribute to adjacent facet joint degeneration? Radiological and clinical analysis following intervertebral fusion

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