Pelvic parameters of sagittal balance in extreme lateral interbody fusion for degenerative lumbar disc disease

Johnson, R.D.; Valore, Annalisa; Villaminar, A.; Comisso, Marina; Balsano, Massimo

doi:10.1016/j.jocn.2012.05.032

Cited by 63 publications

(54 citation statements)

References 18 publications

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“…Other researchers have affirmed the reliable correction of coronal Cobb angle, but differ on their correction of lumbar lordosis. 2,24,25 In our study, we found a significant change in GLL from 28.9 degrees pre-operatively to 35.2 degrees at the first post-operative timepoint and a significant improvement in LSL from 40.0 degrees pre-operatively to 46.7 and 45.9 degrees as the first and final postoperative timepoints, respectively.…”

Section: Discussionsupporting

confidence: 56%

“…Lateral interbody fusion (LIF) is a newer technique that has grown in popularity among surgeons due to the limited exposure, decreased operative time and avoidance of the risks and morbidities of the anterior approach: visceral injury, post-operative ileus, ventral hernia, and neurovascular injury. 2 Lateral interbody fusion techniques have been shown to yield higher fusion rates and improvement in lumbar lordosis as well as less morbidity than conventional anterior and posterior approaches. 3,4 Sagittal balance is the center-of-mass vector of the spine determined by the reciprocal curves of thoracic kyphosis and lumbar lordosis.…”

Section: Introductionmentioning

confidence: 99%

“…2,6 However, despite these demonstrated improvements, there is only limited data evaluating the potential of LIF to restore or improve sagittal balance. In the study herein, the change in sagittal balance and coronal Cobb angle is measured following an LIF with posterior fixation.…”

Section: Introductionmentioning

confidence: 99%

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Sagittal Balance Correction in Lateral Interbody Fusion for Degenerative Scoliosis

et al. 2016

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Background Sagittal balance restoration has been shown to be an important determinant of outcomes in corrective surgery for degenerative scoliosis. Lateral interbody fusion (LIF) is a less-invasive technique which permits the placement of a high lordosis interbody cage without risks associated with traditional anterior or transforaminal interbody techniques. Studies have shown improvement in lumbar lordosis following LIF, but only one other study has assessed sagittal balance in this population. The objective of this study is to evaluate the ability of LIF to restore sagittal balance in degenerative lumbar scoliosis.

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Section: Discussionsupporting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

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Sagittal Balance Correction in Lateral Interbody Fusion for Degenerative Scoliosis

et al. 2016

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“…3,7,13,21 Specifically, there has been an absence of analysis with respect to SVA, pelvic tilt, and the relationship between lumbar lordosis and pelvic incidence. 20 Schwab et al delineated the importance of the pelvis when considering the spine in terms of balance and alignment.…”

Section: Discussionmentioning

confidence: 99%

Limitations and ceiling effects with circumferential minimally invasive correction techniques for adult scoliosis: analysis of radiological outcomes over a 7-year experience

Anand¹,

Baron

Khandehroo³

2014

FOC

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Object Minimally invasive correction of adult scoliosis is a surgical method increasing in popularity. Limited data exist, however, as to how effective these methodologies are in achieving coronal plane and sagittal plane correction in addition to improving spinopelvic parameters. This study serves to quantify how much correction is possible with present circumferential minimally invasive surgical (cMIS) methods. Methods Ninety patients were selected from a database of 187 patients who underwent cMIS scoliosis correction. All patients had a Cobb angle greater than 15°, 3 or more levels fused, and availability of preoperative and postoperative 36-inch standing radiographs. The mean duration of follow-up was 37 months. Preoperative and postoperative Cobb angle, sagittal vertical axis (SVA), coronal balance, lumbar lordosis (LL), and pelvic incidence (PI) were measured. Scatter plots were performed comparing the pre- and postoperative radiological parameters to calculate ceiling effects for SVA correction, Cobb angle correction, and PI-LL mismatch correction. Results The mean preoperative SVA value was 60 mm (range 11.5–151 mm); the mean postoperative value was 31 mm (range 0–84 mm). The maximum SVA correction achieved with cMIS techniques in any of the cases was 89 mm. In terms of coronal Cobb angle, a mean correction of 61% was noted, with a mean preoperative value of 35.8° (range 15°–74.7°) and a mean postoperative value of 13.9° (range 0°–32.5°). A ceiling effect for Cobb angle correction was noted at 42°. The ability to correct the PI-LL mismatch to 10° was limited to cases in which the preoperative PI-LL mismatch was 38° or less. Conclusions Circumferential MIS techniques as currently used for the treatment of adult scoliosis have limitations in terms of their ability to achieve SVA correction and lumbar lordosis. When the preoperative SVA is greater than 100 mm and a substantial amount of lumbar lordosis is needed, as determined by spinopelvic parameter calculations, surgeons should consider osteotomies or other techniques that may achieve more lordosis.

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“…Lateral lumbar interbody fusion (LLIF) through a minimally-invasive surgery (MIS) approach is increasingly being utilized in isolation to achieve a large surface-area interbody fusion with an indirect decompression for spinal stenosis (6)(7)(8)(9)(10). This technique forgoes posterior fixation with a pedicle screw-rod construct in the appropriately selected patient with a stable spinal segment.…”

Section: Introductionmentioning

confidence: 99%

Radiographic and Surgical Outcomes After Stand-Alone Lateral Lumbar Interbody Fusion

Khalsa¹,

Ledesma

Hosseini

et al. 2018

Shafa Ortho J

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Objectives: Lateral lumbar interbody fusion (LLIF) is increasingly being utilized in isolation to achieve a large surface-area interbody fusion with an indirect decompression for spinal stenosis. This retrospective chart review was done to determine the viability of performing stand-alone (SA) LLIF. Methods: Forty-nine patients at least 18 years of age with minimum one-year follow-up at a single institution underwent SA-LLIF using minimally invasive surgery (MIS) approach without further posterior surgery between 2011 and 2015. One to five-level fusions were included. Retrospective review of surgical outcomes and radiographic parameters were examined preoperatively, acutely postoperatively and at 1 year postoperatively.Results: Forty-nine patients (102 spinal segments) underwent SA-LLIF. Fusion levels ranged from one to five with a mean of 2.1 ± 2.1. Mean blood loss was 68 ± 63.2cc and mean surgical time was 143.4 ± 66.5 minutes. Fifty-seven percent had undergone prior spine surgery unrelated to their index procedure. Complication rate was 38.9% and reoperation rate was 20.4%. No difference in complication rates was noted between constructs with three or more levels fused versus less than three levels fused. At one-year, significant improvement was noted with pelvic tilt, pelvic incidence, and lumbar lordosis. Conclusions: SA-LLIF is an optional MIS treatment of stable degenerative disc disease and spinal stenosis, with good one-year correction and maintenance of radiographic parameters. With complication rate of 38.9% and reoperation rate of 20.4%, true benefit of forgoing posterior supplemental fixation may be questioned.

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Pelvic parameters of sagittal balance in extreme lateral interbody fusion for degenerative lumbar disc disease

Cited by 63 publications

References 18 publications

Sagittal Balance Correction in Lateral Interbody Fusion for Degenerative Scoliosis

Sagittal Balance Correction in Lateral Interbody Fusion for Degenerative Scoliosis

Limitations and ceiling effects with circumferential minimally invasive correction techniques for adult scoliosis: analysis of radiological outcomes over a 7-year experience

Radiographic and Surgical Outcomes After Stand-Alone Lateral Lumbar Interbody Fusion

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