Relationship between sagittal balance and adjacent segment disease in surgical treatment of degenerative lumbar spine disease: meta-analysis and implications for choice of fusion technique

Phan, Kevin; Nazareth, Alexander; Hussain, Awais K.; Dmytriw, Adam A; Nambiar, Mithun; Nguyen, Damian; Kerferd, Jack; Phan, Steven; Sutterlin, Chet; Cho, Samuel K.; Mobbs, Ralph J.

doi:10.1007/s00586-018-5629-6

Cited by 81 publications

(76 citation statements)

References 49 publications

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“…Daher gilt es auch bei sog. "kleinen" und "kurzstreckigen" Fusionseingriffen Balance zu bewahren und Alignment zu beachten [16,18] (▶ Abb. 6a-d).…”

Section: Prävention Anschlussinstabilität: Biomechanik Und Biologieunclassified

“…Nachdem die publizierte Literatur und der erlebte klinische Alltag gezeigt haben, dass bei langstreckigen Fusionen der Wiederherstellung der sagittalen Balance eine immense Bedeutung zukommt, haben Studien ihren Einfluss auch bei kurzstreckigen Fusionseingriffen im Bereich der degenerativen [16,18] technischen Standards ist erprobt und auch recht einfach umsetzbar.…”

Section: Die Kurzstreckige Degenerative Und Traumatologische Fusionscunclassified

“…Fakt ist, dass die fehlende Einstellung physiologischer Segmentverhältnisse im degenerativen Fusionsfeld zur Kompensation in Nachbarbereichen führt. Eine beschleunigte Anschlussdegeneration mit klinischer Dekompensation kann die Folge sein[16,18]. Die Korrektur des sagittalen regionalen Profils ist bei einer Folgeoperation dann erschwert.…”

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Sagittales Profil der Wirbelsäule: Was ist sinnvoll, was gefährdet den Patienten, was ist Hype ? Pro: Korrektur ist oberste Maxime

Koller

2019

Die Wirbelsäule

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ZusammenfassungDie Notwendigkeit der Rekonstruktion eines physiologischen sagittalen Wirbelsäulenprofils bei Wirbelsäulenoperationen wird regelhaft in Fachdiskussionen kritisch hinterfragt. Die Gründe dafür liegen in der Natur sog. Deformitäteneingriffe, welche eine gesteigerte Komplexizität, operativen Schweregrad und auch Komplikationspotenzial mit sich führen. Der vorliegende Artikel erarbeitet ausführlich die Bedeutung der Rekonstruktion eines spinalen Alignments und einer sagittalen spinalen Balance. Vorteile und potenzielle Schwierigkeiten sowie Herausforderungen werden ausgewogen dargestellt. Die klinische Erfahrung, gestützt von wachsender publizierter Evidenz, bestärkt den Wirbelsäulenchirurgen in seinem Auftrag, auch die spinale sagittale Balance bei Wirbelsäuleneingriffen zu wahren und bei Bedarf auch zu rekonstruieren.

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“…Daher gilt es auch bei sog. "kleinen" und "kurzstreckigen" Fusionseingriffen Balance zu bewahren und Alignment zu beachten [16,18] (▶ Abb. 6a-d).…”

Section: Prävention Anschlussinstabilität: Biomechanik Und Biologieunclassified

Section: Die Kurzstreckige Degenerative Und Traumatologische Fusionscunclassified

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Sagittales Profil der Wirbelsäule: Was ist sinnvoll, was gefährdet den Patienten, was ist Hype ? Pro: Korrektur ist oberste Maxime

Koller

2019

Die Wirbelsäule

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“…Although strong internal fixation may lead to decreased spinal mobility in the surgical segment, it also increased intervertebral disc and articular stress in adjacent segments and may increase the potential risk of adjacent segment degeneration (ASD) [9]. ASD refers to the degeneration of cranial and caudal segments after spinal fusion surgery, and the incidence of ASD is approximately 8-100% [10,11]. Patients may have changes detected only by imaging or clinical symptoms, and severe cases even require surgical revision [12].…”

Section: Introductionmentioning

confidence: 99%

Influence of cement-augmented pedicle screw instrumentation in an osteoporotic lumbosacral spine over the adjacent segments: a 3D finite element study

Zhou

Zeng

et al. 2020

J Orthop Surg Res

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To compare the effect of conventional pedicle screw (CPS) and cement-augmented pedicle screw instrumentation (CAPSI) on adjacent segment degeneration (ASD). Methods: A normal male volunteer without a history of spinal disease was selected, lumbar CT data was collected, an intact L3-S1 three-dimensional finite element model was created by software including Mimics, Geomagic, and SolidWorks, and the fixation methods were performed accordingly. A common pedicle screw model and a cementaugmented pedicle screw model of L4-L5 with fusion and internal fixation were constructed. With ANSYS Workbench 17.0, a 500 N load was applied to the upper surface of L3 to simulate the weight of a human body, and a 7.5 N m moment was applied at the neutral point to simulate flexion, extension, left/right bending, left/right rotation of the spine. The peak von Mises stress of intervertebral disc and the range of motion (ROM) on the adjacent segments (L3-4 and L5-S1) were compared. Results: The validity of the intact model shows that the ROM of the model is similar to that of a cadaveric study. Compared with the intact model, CPS model and CAPSI model in all motion patterns increased the ROM of adjacent segments. The intervertebral disc stress and the ROM of adjacent segments were found to be higher in the CAPSI model than in the CPS model, especially in L3-4. Conclusion: In general, the biomechanical analysis of an osteoporotic lumbar spine showed that both CPS and CAPSI can increase the ROM and disc stresses of osteoporotic lumbar models, and compared with CPS, CAPSI is more likely to increase the potential risk of adjacent segment degeneration.

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“…[7][8][9] Therefore, evaluations of spinal sagittal balance frequently inform surgical decision-making in lumbar degenerative disease. [10][11][12] Various lumbar interbody fusion techniques have been developed for the management of lumbar degenerative disease, and are thought to be superior to conservative treatment. Fusion techniques confer several theoretical advantages, such as restoration of the disc height (DH), correction of spinal sagittal balance, and decompression of the neural foramina.…”

Section: Introductionmentioning

confidence: 99%

Lumbar degenerative disease after oblique lateral interbody fusion:sagittal spinopelvic alignment and its impact on low back pain

Zhang

Shen

et al. 2020

Preprint

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Background: We determined the incidence and risk factors of low back pain (LBP) in patients with lumbar degenerative disease after single-level oblique lateral interbody fusion (OLIF). Methods: We retrospectively reviewed 120 lumbar degenerative disease patients who underwent single-level OLIF. We compared preoperative and postoperative radiographic parameters, including segmental lordosis (SL), lumbar lordosis (LL), disk height (DH), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), C7-sagittal vertical axis (SVA). Clinical outcomes were evaluated using Oswestry Disability Index (ODI) scores and visual analog scale (VAS) scores for back and leg pain. All patients were followed up for at least 2 years. Results: Thirty-eight patients had postoperative LBP (VAS score for back pain ≥ 3; LBP group); the remaining 82 patients were in the non-LBP group. Age (P = 0.082), gender (P = 0.425), body mass index (P = 0.138), diagnosis (degenerative spondylolisthesis vs. lumbar spinal stenosis; P = 0.529), surgical level (P = 0.651), blood loss (P = 0.889), and operative time (P = 0.731) did not differ between the groups. In both groups, the ODI and VAS scores for back pain and leg pain significantly improved at the final follow-up compared to the preoperative scores (P = 0.003). Except for the VAS score for back pain (P = 0.000), none of the scores significantly differed between the two groups at the final follow-up (P > 0.05). In the non-LBP group, LL, SL, DH, TK, and SS significantly improved, while PT and C7-SVA significantly decreased at the final follow-up as compared to the preoperative values. In both groups, DH significantly improved postoperatively, with no significant between-group difference (P = 0.325). At the final follow-up, LL, PI-LL mismatch, PT, and C7-SVA showed significantly greater improvement in the non-LBP group than in the LBP group (P < 0.05). Multivariate analysis identified PT, PI-LL mismatch, and C7-SVA as significant risk factors for LBP after OLIF. Conclusion: OLIF for single-level lumbar degenerative disease had satisfactory clinical outcomes. PT, PI-LL mismatch, and C7-SVA were significant risk factors for postoperative LBP. Patients with appropriately decreased PT, improved C7-SVA, and PI-LL match experienced less LBP.

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Relationship between sagittal balance and adjacent segment disease in surgical treatment of degenerative lumbar spine disease: meta-analysis and implications for choice of fusion technique

Cited by 81 publications

References 49 publications

Sagittales Profil der Wirbelsäule: Was ist sinnvoll, was gefährdet den Patienten, was ist Hype ? Pro: Korrektur ist oberste Maxime

Sagittales Profil der Wirbelsäule: Was ist sinnvoll, was gefährdet den Patienten, was ist Hype ? Pro: Korrektur ist oberste Maxime

Influence of cement-augmented pedicle screw instrumentation in an osteoporotic lumbosacral spine over the adjacent segments: a 3D finite element study

Lumbar degenerative disease after oblique lateral interbody fusion:sagittal spinopelvic alignment and its impact on low back pain

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