Lordosis Distribution Index in Short-Segment Lumbar Spine Fusion – Can Ideal Lordosis Reduce Revision Surgery and Iatrogenic Deformity?

Bari, Tanvir Johanning; Heegaard, Martin; Bech-Azeddine, Rachid; Dahl, Benny; Gehrchen, Martin

doi:10.14245/ns.2040744.372

Cited by 25 publications

(22 citation statements)

References 40 publications

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“…Second, the PI values of patients are widely distributed, and the characteristics of the correlation with LL or PT may differ depending on the range of PI values. 26 But in our study, additional research could not be conducted due to the small number of the patients. If analysis according to this PI distribution is added in the future, more clear results could be derived.…”

Section: Discussionmentioning

confidence: 87%

Pelvic Incidence–Lumbar Lordosis Mismatch Is Predisposed to Adjacent Segment Degeneration After Single-Level Anterior Lumbar Interbody Fusion: A Retrospective Case-Control Study

Yoon

Lee

Lee³

2023

Neurospine

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Objective: Spinopelvic parameters play important roles in clinical outcomes and disability after short-segment fusion surgery for degenerative spine disease. This study aimed to investigate the relationship between preoperative or postoperative spinopelvic parameters and symptomatic adjacent segment degeneration (ASD) after single-level anterior lumbar interbody fusion (ALIF) surgery at the L4–5 segments.Methods: All patients who underwent single-level ALIF at the L4–5 level from January 2010 to December 2013 and were followed up for 5 years were analyzed. We collected the degree of degeneration at adjacent segments and preoperative and postoperative spinopelvic parameters. We compared the preoperative and postoperative parameters between patients with and without symptomatic ASD.Results: Sixty-one patients were included in our study, and 30 patients had symptomatic ASD. Degeneration at adjacent segments and preoperative spinopelvic parameters did not affect the occurrence of symptomatic ASD. Patients with symptomatic ASD had higher postoperative pelvic tilt (PT) and a mismatch between lumbar lordosis (LL) and pelvic incidence (PI) compared to those without. Postoperative PT > 15° and PI–LL mismatch > 10° were significant risk factors for symptomatic ASD.Conclusion: High PT and PI–LL mismatch were significant risk factors for symptomatic ASD after single-level ALIF surgery. Spine surgeons should consider achieving proper LL to insert the cage at the appropriate angle and prevent a PI–LL mismatch value > 10° after single-level fusion surgery.

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Section: Discussionmentioning

confidence: 87%

Pelvic Incidence–Lumbar Lordosis Mismatch Is Predisposed to Adjacent Segment Degeneration After Single-Level Anterior Lumbar Interbody Fusion: A Retrospective Case-Control Study

Yoon

Lee

Lee³

2023

Neurospine

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“…However, as shown in Table 5, patients with ASD showed significantly more decrease in residual lumbar lordosis than those without ASD (16.4° vs −1.0°), indicating that this compensation might exert more pressure in adjacent segments and be related to ASD. Previous studies also reported that an abnormal lordosis distribution index (LDI) could increase the stress of adjacent segments 32–34 . Zheng et al 35 .…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies also reported that an abnormal lordosis distribution index (LDI) could increase the stress of adjacent segments. 32 , 33 , 34 Zheng et al . 35 found that patients with moderate postoperative LDI showed the lowest risk to develop ASD after L4‐S1 posterior lumbar interbody fusion, while the patients with low LDI were at higher risk to develop ASD.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies also reported that an abnormal lordosis distribution index (LDI) could increase the stress of adjacent segments. [32][33][34] Zheng et al 35 found that patients with moderate postoperative LDI showed the lowest risk to develop ASD after L4-S1 posterior lumbar interbody fusion, while the patients with low LDI were at higher risk to develop ASD. Consistent with our findings, the overcompensation of adjacent segments in sitting positions could also influence the lordosis distribution and increase the stress in the adjacent segments, resulting in ASD.…”

Section: The Relationship Between Postoperative Compensation and Dege...mentioning

confidence: 99%

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The Standing and Sitting Spino‐Pelvic Sagittal Alignment in Patients with Instrumented Lumbar Fusion Might Correlate with Adjacent Segment Degeneration

Zhou

Zhong

Sun

et al. 2022

Orthopaedic Surgery

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Objectives: Sitting is a common weight-bearing posture, like standing, but there still lacks enough understanding of sagittal alignment in sitting position for patients after lumbar fusion. This study aimed to investigate the accommodation of fixed spine from standing to sitting position and its influence on unfused segments.Methods: Sixty-two patients after lumbar fusion (test group) and 40 healthy volunteers (control group) were recruited in this research. All subjects underwent lateral radiographs of entire spine in the standing and sitting positions. The spinopelvic parameters including sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), and pelvic tilt (PT) were measured. The changes in parameters of patients between two positions were compared with control group, and patients were divided in different groups based on fusion level and their parameters were compared.Results: When changing from standing to sitting positions, a forward-moving SVA and TPA were observed in both patients and control groups, accompanied by the decrease in LL, TK and increase in PT, but the changes of patients were smaller in TPA, LL, and TK (6.5 AE 7.2 vs 9.7 AE 6.0 , 7.7 AE 8.3 vs 13.6 AE 8.5 , 2.2 AE 6.5 vs 5.4 AE 5.1 , respectively, p < 0.05). Increase of PT in the lumbosacral fixation group was lower than that in the control group (4.4 AE 9.1 vs 8.3 AE 7.1 , p < 0.05). Patients who had adjacent segments degeneration (ASD) showed more kyphosis in unfused lumbar segments than the other patients (16.4 AE 10.7 vs À1.0 AE 4.8 , p < 0.05) from standing to sitting. Conclusions:The spine straightens in lumbar and thoracic curve, combined with forward-moving axis and pelvic retroversion when changing to the sitting position. However, these changes are relatively limited in patients after lumbar fusion, so the adjacent unfused lumbar segments compensate to stress during sitting and this may be related to ASD.

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“…The use of large cages also allows greater lordosis to be achieved especially in the lower lumbar segments thus, improve the lordosis distribution index and reduce the risks of revision surgery in the future. 25 There is an increasing interest in 3D-printed titanium cages in lumbar spinal fusion. We used 3D-printed titanium cages in our cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

Spinal Canal Remodeling and Indirect Decompression of Contralateral Foraminal Stenosis After Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion

Lau

Kim

et al. 2023

Neurospine

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Objective: There is a lack of literature on indirect decompression in uniportal endoscopic posterolateral transforaminal lumbar interbody fusion (EPTLIF). Our aim is to evaluate the dimensions of the spinal canal and contralateral foramen before and after EPTLIF.Methods: This is a retrospective study of patients who underwent EPTLIF in a tertiary spine centre over a 2-year period. The cross-sectional area of the spinal canal and the contralateral foramen at the level of fusion were measured on magnetic resonance imaging scan at 1-day postoperation and at the final follow-up. Patients were grouped according to the decompression performed as per the clinician’s judgement.Results: One hundred fifty-two levels of fusion were performed in 120 patients. There was a statistically significant clinical improvement in visual analogue scale and Oswestry Disability Index scores postoperation. The measurements of the spinal canal area were 106.0 mm2, 138.8 mm2, and 195.5 mm2; while contralateral foraminal area were 73.2 mm2, 104.4 mm2, and 120.7 mm2 at preoperation, 1-day postoperation, and at the final follow-up, respectively (p < 0.001). For the subgroup analyses, spinal canal area measurements for the bilateral decompression cohort (n = 35) were 57.0 mm2, 123.9 mm2, and 191.8 mm2; for the ipsilateral decompression cohort (n = 42) were 89.3 mm2, 128.9 mm2, 183.3 mm2; and for the cohort without any decompression and only cage inserted (n = 75) were 138.3 mm2, 151.2 mm2, and 204.1 mm2 (p < 0.001). Contralateral foraminal area measurements were 73.3 mm2, 106.4 mm2 and 120.4 mm2 in the bilateral decompression cohort; 69.5 mm2, 99.0 mm2, 116.9 mm2 in the ipsilateral decompression cohort; and 75.1 mm2, 106.5 mm2, 122.9 mm2 in the cohort without any decompression (p < 0.001).Conclusion: Indirect decompression of both the spinal canal and the contralateral foramen can be achieved via EPTLIF. Decompression on an asymptomatic contralateral side is not necessary.

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Lordosis Distribution Index in Short-Segment Lumbar Spine Fusion – Can Ideal Lordosis Reduce Revision Surgery and Iatrogenic Deformity?

Cited by 25 publications

References 40 publications

Pelvic Incidence–Lumbar Lordosis Mismatch Is Predisposed to Adjacent Segment Degeneration After Single-Level Anterior Lumbar Interbody Fusion: A Retrospective Case-Control Study

Pelvic Incidence–Lumbar Lordosis Mismatch Is Predisposed to Adjacent Segment Degeneration After Single-Level Anterior Lumbar Interbody Fusion: A Retrospective Case-Control Study

The Standing and Sitting Spino‐Pelvic Sagittal Alignment in Patients with Instrumented Lumbar Fusion Might Correlate with Adjacent Segment Degeneration

Spinal Canal Remodeling and Indirect Decompression of Contralateral Foraminal Stenosis After Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion

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