Influence of Preoperative Difference in Lumbar Lordosis Between the Standing and Supine Positions on Clinical Outcomes After Single-level Transforaminal Lumbar Interbody Fusion

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 AE 11.3 years old; 24 males) treated with singlelevel 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 >À48, and D-LL À48). 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 >À48 group were significantly worse than in the D-LL À48 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.

L1 slope: an overlooked spinal parameter

“…Therefore, the mean L1S, LL, and SS values reported for this group were very close to that of healthy subjects and can be accepted as an asymptomatic group. On the other hand, we thought that evaluation of spinopelvic parameters in supine position strengthened our study, because the importance of supine imaging tools has been increasing for several reasons [ 26 – 28 ]. First, the correlation between the spinopelvic parameters are strongest in the supine position and lumbosacral sagittal alingment in the supine position is appromixately equal to that in the prone position which is actually intraoperative position, so supine images can be helpful for the surgical planing [ 26 ].…”

“…First, the correlation between the spinopelvic parameters are strongest in the supine position and lumbosacral sagittal alingment in the supine position is appromixately equal to that in the prone position which is actually intraoperative position, so supine images can be helpful for the surgical planing [ 26 ]. Second, the difference between LL values measured in supine and standing position was found correlated with postoperative outcome in the patients with adult spinal deformity [ 27 , 28 ]. We believe that supine imaging will be utilized more commonly in the future for the diagnosis and the treatment of spinal disease.…”

Changes in lumbar lordosis and predicted minimum 5-year surgical outcomes after short-segment transforaminal lumbar interbody fusion

“…Previous studies have reported that a higher PI-LL value is associated with worse postoperative clinical outcomes and higher incidence of ASD after lumbar fusion surgery 7 , 9 , 10 . Ohyama et al reported that DiLL is associated with short-term surgical outcomes after TLIF 13 . Moreover, the results of this study revealed that the mid-term clinical outcomes were significantly correlated with DiLL.…”

“…Future studies with more patients are warranted to more precisely investigate the incidence of S-ASD between the groups and the influence of a combination of DiLL and PI-LL on the postoperative outcomes. Fourth, there are no background data supporting the appropriateness of classifying patients into DiLL (+) and DiLL (−) groups because DiLL is a newly proposed lumbopelvic parameter 13 . In the future, further studies are needed to clarify the cut-off value for DiLL for classifying patients with normal or abnormal lumbar function.…”

“…The preoperative postural difference in lumbar lordosis (LL) between the standing and supine positions (DiLL) has recently been reported to be correlated with short-term postoperative clinical outcomes after single-level TLIF 13 . The report concluded that patients with higher preoperative DiLL values tended to show worse postoperative residual symptoms such as lower extremity symptoms, low back pain (LBP) upon standing, and gait disturbance 2 years after TLIF 13 . However, mid- to long-term postoperative clinical outcomes relative to the preoperative DiLL have not been reported.…”