Impact of lordotic cages in the restoration of spinopelvic parameters after dorsal lumbar interbody fusion: a retrospective case control study

Abstract

Purpose Aim of this study was to compare the reconstruction of radiological sagittal spinopelvic parameters between lordotic (10°) and normal cages (0°) after dorsal lumbar spondylodesis. Methods This retrospective monocentric study included patients who received dorsal lumbar spondylodesis between January 2014 and December 2018. Inclusion criteria were degenerative lumbar diseases and mono-or bi-segmental fusions in the middle and lower lumbar region. Exclusion criteria were long-distance fusions (3 segments and more) and infectious and tumour-related diseases. The sagittal spinopelvine parameters (lumbar lordosis, segmental lordosis, sacral slope, pelvic incidence, and pelvic tilt) were measured pre-and post-operatively by two examiners at two different times. The patients were divided into 2 groups (group 1: lordotic cage, group 2: normal cage). Results One hundred thirty-eight patients (77 female, 61 male) with an average age of 66.6 ± 11.2 years (min.: 26, max.: 90) were included in the study based on the inclusion criteria. Ninety-two patients (66.7%) received 0°cages and 46 (33.3%) lordotic cages (10°). Segmental lordosis was increased by 4.2°on average in group 1 and by 6.5°in group 2 (p = 0.074). Average lumbar lordosis was increased by 2.1°in group 1 and by 0.6°in group 2 (p = 0.378). There was no significant difference in the correction of sagittal spinopelvic parameters. Inter-and inter-class reliability was between 0.887 and 0.956. Conclusion According to the results of our study, no advantages regarding sagittal radiological parameters for the implantation of a lordotic cage could be demonstrated.

Risk Factors for Adjacent Segment Disease in Short Segment Lumbar Interbody Fusion—A Case Series

“…Fifty-five percent of cages in our cohort were lordotic, and these were found to be protective for ASD. Oikonomidis et al 23 however reported in a retrospective study that the use of lordotic cages of 10°did not provide a significant impact on sagittal parameters. Another retrospective study from Hong et al found that 15°lordotic cages improved postoperative lumbar lordosis 24 without a comment on how this affected ASD.…”

Spinopelvic Parameters in the Clinical and Functional Outcomes of Patients Submitted to Lumbar Interbody Fusion Surgery – A Prospective Study

“…It has been recognized that abnormal sagittal alignment changes after long-segment lumbar interbody fusion are related to worse clinical outcomes. 3 11 The persistence of low-back pain after lumbar interbody fusion surgery seems to be correlated with a more sacral verticalization, that is, excessive retroversion of the pelvis, with less SS and more PT, associated with a decrease in LL. 12 Also, older age, high preoperative PT, and a postoperative PI-LL ≥ 10° were identified as risk factors for reduced quality of life after lumbar interbody fusion surgery.…”

Comparison of novel stabilisation device with various stabilisation approaches: A finite element based biomechanical analysis

“…Few researchers also revealed that the interbody fusion with rigid fixation may be an alternative to stabilise and restore spinal deformities. 11–13 Furthermore, recently semi-rigid stabilisation has been instigated and to be augmented with cages to attain a better fusion. 14 Various non-rigid instrumentations are also available for the spinal treatment, are stated as flexible/dynamic.…”