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Global Sagittal Alignment and Clinical Outcomes after 1–3 Short-Segment Lumbar Fusion in Degenerative Spinal Diseases

STUDY DESIGN: Level III retrospective study. PURPOSE: We investigated the impact of short-segment lumbar fusion on the restoration of global sagittal alignment and the correlations between spino-pelvic parameters and clinical outcomes. OVERVIEW OF LITERATURE: Sagittal imbalance leads to energy consu...

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Autores principales: Youn, Yung-Hun, Cho, Kyu-Jung, Na, Yeop, Kim, Jeong-Seok
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Spine Surgery 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441428/
https://www.ncbi.nlm.nih.gov/pubmed/34551501
http://dx.doi.org/10.31616/asj.2021.0182
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author Youn, Yung-Hun
Cho, Kyu-Jung
Na, Yeop
Kim, Jeong-Seok
author_facet Youn, Yung-Hun
Cho, Kyu-Jung
Na, Yeop
Kim, Jeong-Seok
author_sort Youn, Yung-Hun
collection PubMed
description STUDY DESIGN: Level III retrospective study. PURPOSE: We investigated the impact of short-segment lumbar fusion on the restoration of global sagittal alignment and the correlations between spino-pelvic parameters and clinical outcomes. OVERVIEW OF LITERATURE: Sagittal imbalance leads to energy consumption and pain in maintaining a standing position. For adult spinal deformity, it is critical to create optimal lumbar lordosis (LL) in order to achieve restoration of sagittal imbalance. However, surgeons do not pay attention to correcting LL in short-segment lumbar fusion. METHODS: A total of 69 patients with transforaminal lumbar interbody fusion (TLIF) for degenerative spinal disease were evaluated with a minimum 2-year follow-up. All patients underwent TLIF with hyper-lordotic angle cages to achieve higher LL. Radiological spino-pelvic parameters including sagittal vertical axis (SVA) and clinical outcomes using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) were evaluated. RESULTS: The average LL was 35.8°±9.9° before surgery, 42.3°±9.3° 1 year after surgery, and 40.3°±10.2° 2 years after surgery (p<0.01). The average SVA was 43.1±6.2 mm before surgery, 21.2±4.9 mm 1 year after surgery, and 34.0±4.7 mm 2 years after surgery (p<0.01). The average LL and SVA improved in two- or three-segment fusion, but not in one-segment fusion. The correlation between ΔLL and ΔSVA was significant in all segment fusions. The correlation between ΔLL and ΔSVA was more significant at the L4–5 and L5–S1 segments than at L3–4. ODI was significantly correlated with SVA (p<0.05). NRS showed no correlation with the radiological parameters. CONCLUSIONS: Two- or three-segment lumbar fusion using hyper-lordotic angle cages improved LL and SVA. A significant correlation between the correction of LL and SVA was found. Higher correction of LL using hyper-lordotic angle cages is thus recommended in short-segment lumbar fusion, since postoperative improvements of SVA significantly affect clinical outcomes.
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spelling pubmed-94414282022-09-12 Global Sagittal Alignment and Clinical Outcomes after 1–3 Short-Segment Lumbar Fusion in Degenerative Spinal Diseases Youn, Yung-Hun Cho, Kyu-Jung Na, Yeop Kim, Jeong-Seok Asian Spine J Clinical Study STUDY DESIGN: Level III retrospective study. PURPOSE: We investigated the impact of short-segment lumbar fusion on the restoration of global sagittal alignment and the correlations between spino-pelvic parameters and clinical outcomes. OVERVIEW OF LITERATURE: Sagittal imbalance leads to energy consumption and pain in maintaining a standing position. For adult spinal deformity, it is critical to create optimal lumbar lordosis (LL) in order to achieve restoration of sagittal imbalance. However, surgeons do not pay attention to correcting LL in short-segment lumbar fusion. METHODS: A total of 69 patients with transforaminal lumbar interbody fusion (TLIF) for degenerative spinal disease were evaluated with a minimum 2-year follow-up. All patients underwent TLIF with hyper-lordotic angle cages to achieve higher LL. Radiological spino-pelvic parameters including sagittal vertical axis (SVA) and clinical outcomes using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) were evaluated. RESULTS: The average LL was 35.8°±9.9° before surgery, 42.3°±9.3° 1 year after surgery, and 40.3°±10.2° 2 years after surgery (p<0.01). The average SVA was 43.1±6.2 mm before surgery, 21.2±4.9 mm 1 year after surgery, and 34.0±4.7 mm 2 years after surgery (p<0.01). The average LL and SVA improved in two- or three-segment fusion, but not in one-segment fusion. The correlation between ΔLL and ΔSVA was significant in all segment fusions. The correlation between ΔLL and ΔSVA was more significant at the L4–5 and L5–S1 segments than at L3–4. ODI was significantly correlated with SVA (p<0.05). NRS showed no correlation with the radiological parameters. CONCLUSIONS: Two- or three-segment lumbar fusion using hyper-lordotic angle cages improved LL and SVA. A significant correlation between the correction of LL and SVA was found. Higher correction of LL using hyper-lordotic angle cages is thus recommended in short-segment lumbar fusion, since postoperative improvements of SVA significantly affect clinical outcomes. Korean Society of Spine Surgery 2022-08 2021-09-28 /pmc/articles/PMC9441428/ /pubmed/34551501 http://dx.doi.org/10.31616/asj.2021.0182 Text en Copyright © 2022 by Korean Society of Spine Surgery https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Youn, Yung-Hun
Cho, Kyu-Jung
Na, Yeop
Kim, Jeong-Seok
Global Sagittal Alignment and Clinical Outcomes after 1–3 Short-Segment Lumbar Fusion in Degenerative Spinal Diseases
title Global Sagittal Alignment and Clinical Outcomes after 1–3 Short-Segment Lumbar Fusion in Degenerative Spinal Diseases
title_full Global Sagittal Alignment and Clinical Outcomes after 1–3 Short-Segment Lumbar Fusion in Degenerative Spinal Diseases
title_fullStr Global Sagittal Alignment and Clinical Outcomes after 1–3 Short-Segment Lumbar Fusion in Degenerative Spinal Diseases
title_full_unstemmed Global Sagittal Alignment and Clinical Outcomes after 1–3 Short-Segment Lumbar Fusion in Degenerative Spinal Diseases
title_short Global Sagittal Alignment and Clinical Outcomes after 1–3 Short-Segment Lumbar Fusion in Degenerative Spinal Diseases
title_sort global sagittal alignment and clinical outcomes after 1–3 short-segment lumbar fusion in degenerative spinal diseases
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441428/
https://www.ncbi.nlm.nih.gov/pubmed/34551501
http://dx.doi.org/10.31616/asj.2021.0182
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