Restoring spinopelvic harmony with lateral lumbar interbody fusion: is it a realistic goal?

Asaid, Mina; Cox, Aram; Breslin, Monique; Siedler, Declan G.; Sutterlin, Chester E.; Dubey, Arvind Kumar

doi:10.21037/jss-20-605

Cited by 4 publications

(3 citation statements)

References 57 publications

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“…In general, it makes sense to place the LLIF cage anterior to obtain the degree of LL 23 , but cases have been reported in which indirect decompression may not be accepted 18 . In addition, although some spinal parameter correction rates after LLIF surgery have been reported, there remains limited evidence about the effectiveness of LLIF surgery to correct sagittal deformities 25 – 28 . Similarly, there are few reports of whether and how preoperative sagittal balance affects pain in specific areas, such as low back pain (LBP), leg pain (LP), and leg numbness (LN), after LLIF surgery.…”

Section: Introductionmentioning

confidence: 99%

Effects of preoperative sagittal spinal imbalance on pain after lateral lumbar interbody fusion

Hiyama

Katoh

Sakai

et al. 2022

Sci Rep

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Sagittal misalignment has been associated with negative quality of life (QOL). However, there is no report on whether differences in preoperative sagittal misalignment in patients with lumbar degenerative diseases affect postoperative results after lateral lumbar interbody fusion (LLIF). We investigated whether preoperative sagittal alignment influences the correction of alignment after surgery and whether the preoperative sagittal alignment affects the rating of low back pain, leg pain, and leg numbness. The subjects were 81 patients (48 male, 33 females, average age at surgery 70.2 years) who underwent anterior–posterior combined surgery with LLIF and percutaneous pedicle screws from May 2018 to July 2020. Cluster analysis was performed using the preoperative sagittal vertical axis (SVA) value, and patients were classified into two groups (group 1; n = 30, SVA = 129.0 ± 53.4 mm, group 2; n = 51, SVA = 30.8 ± 23.5 mm). Baseline demographics and treatment data were compared between groups. Sagittal and pelvic parameters and pain scores, such as low back pain, leg pain, and leg numbness, were also compared. Operative time, blood loss, and length of hospital stay did not differ significantly between groups. The changes (Δ) in SVA and lumbar lordosis (LL) for all patients from before to after surgery were not significant (ΔSVA; p = 0.218, ΔLL; p = 0.189, respectively). The SVA, LL, and PI − LL changed significantly after the surgery in group 1, but no marked improvement in sagittal imbalance was obtained after LLIF surgery. The improvement in each pain score from before to after the surgery did not differ significantly between groups. LLIF surgery has a limited chance of recovering sagittal imbalance. However, postoperative low back pain, leg pain, and leg numbness may be improved by LLIF surgery, regardless of the preoperative sagittal alignment.

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Section: Introductionmentioning

confidence: 99%

Effects of preoperative sagittal spinal imbalance on pain after lateral lumbar interbody fusion

Hiyama

Katoh

Sakai

et al. 2022

Sci Rep

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“…Regarding spine surgery, evaluating spinal alignment before surgery is routinely performed because there are reports of a significant relationship between sagittal alignment and postoperative patient-reported outcome scores [1][2][3]. The current first choice for assessing sagittal alignment is a whole-spine standing lateral radiograph, which is simple, easy to access, cost-effective, and involve a single brief exposure [4].…”

Section: Introductionmentioning

confidence: 99%

“…SVA (sagittal vertical axis), CL (cervical lordosis), TK (thoracic kyphosis), TL (thoracolumbar angle), LL (lumbar lordosis), SS (sacral slope), PT (pelvic tilt), PI (pelvic incidence), T1 slope (angle between a horizontal line and the superior endplate of T1), C2-C4 (Cobb's angle between the inferior endplates of C2 and C4), and C4-T1 (Cobb's angle between the inferior endplates of C2 and C4) 2. Statistically significant difference 3. Standard deviation.…”

mentioning

confidence: 99%

Variation in Sagittal Alignment Parameters in Adult Patients before Spine Surgery: A Serial Imaging Study Using Antero-Posterior and Latero-Lateral Projections

Lim

Lee

et al. 2021

Diagnostics

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Sagittal parameters of the spine are closely related to the evaluation and treatment of spine disease. However, there has been little research on variations in preoperative sagittal spinal alignment. This study was conducted to assess the variation in sagittal spinal alignment on serial antero-posterior and latero-lateral projections (EOS imaging) in adult patients before spine surgery. The sagittal parameters of 66 patients were collected from two serial images. Comparison between the first and second sagittal parameters was evaluated using the Wilcoxon signed-rank test. Subgroup analysis was performed based on the time interval between radiographs, patient’s age, and type of surgery. The sagittal vertical axis (SVA) exhibited statistically significant changes (p = 0.023), with the mean SVA increasing statistically (61.7 mm vs. 73.6 mm) and standard deviation increasing (51.5 mm vs. 61.6 mm) in the second image. Subgroup analysis showed significant differences in SVA (p = 0.034) in patients with an interval of >3 months; statistical differences in borderline levels in the SVA (p = 0.049) were observed in patients aged >65 years. Other parameters did not show statistically significant differences, except for SVA. Furthermore, SVA differences were statistically significant with increases in the EOS interval (>3 months) and patient age (>65 years).

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The impact of interbody approach and lumbar level on segmental, adjacent, and sagittal alignment in degenerative lumbar pathology: a radiographic analysis six months following surgery

et al. 2022

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Restoring spinopelvic harmony with lateral lumbar interbody fusion: is it a realistic goal?

Cited by 4 publications

References 57 publications

Effects of preoperative sagittal spinal imbalance on pain after lateral lumbar interbody fusion

Effects of preoperative sagittal spinal imbalance on pain after lateral lumbar interbody fusion

Variation in Sagittal Alignment Parameters in Adult Patients before Spine Surgery: A Serial Imaging Study Using Antero-Posterior and Latero-Lateral Projections

The impact of interbody approach and lumbar level on segmental, adjacent, and sagittal alignment in degenerative lumbar pathology: a radiographic analysis six months following surgery

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