Analysis of Spinopelvic Sagittal Balance and Persistent Low Back Pain (PLBP) for Degenerative Spondylolisthesis (DS) following Posterior Lumbar Interbody Fusion (PLIF)

He, Shuangjun; Zhang, Yijian; Ji, Wei; Liu, Hao; He, Fan; Chen, Angela Carley; Yang, Huilin; Pi, Bin

doi:10.1155/2020/5971937

Cited by 18 publications

(21 citation statements)

References 31 publications

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“…At the same time, the improvement of the spinal alignment also reduced the work and strain of the back muscles, thereby relieving postoperative back pain. This result is basically consistent with the previous research [ 22 , 23 , 26 , 31 , 33 ]. In addition, it is considered that sagittal imbalance is an interactive phenomenon that is accompanied with alteration of LL, SS, PI and PT [ 34 ].…”

Section: Discussionsupporting

confidence: 94%

Radiographic and clinical outcomes of surgical treatment of Kümmell’s disease with thoracolumbar kyphosis: a minimal two-year follow-up

Cheng

Wang

et al. 2021

BMC Musculoskelet Disord

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Background Up to now in the surgical treatment of Kümmell’s disease combined with thoracolumbar kyphosis, little research has focused on the evaluation of the imaging and clinical outcomes of restoring the normal alignment and sagittal balance of the spine. This study aimed to evaluate the short to mid-term radiographic and clinical outcomes in the treatment of Kümmell’s disease with thoracolumbar kyphosis. Methods From February 2016 to May 2018, 30 cases of Kümmell’s disease with thoracolumbar kyphosis were divided into group A and B according to whether the kyphosis was combined with neurological deficits. All of the cases underwent surgical treatment to regain the normal spinal alignment and sagittal balance. The radiographic outcomes and clinical outcomes of the cases were retrospectively evaluated. The sagittal imaging parameters including sagittal vertebral axis (SVA),thoracic kyphosis (TK),thoracolumbar kyphosis (TLK),lumbar lordosis (LL),pelvic incidence (PI),pelvic tilt (PT),and sacral slope (SS) before operation,immediately after operation,and the last follow-up of each case were measured and evaluated. The clinical results included the Oswestry Disability Index (ODI) and the Numerical Rating Scale (NRS) of the two groups. Statistical software SPSS21.0 was used to analyze the data. Results In group A: Mean SVA before operation was 75 mm and 26.7 mm at the final postoperative evaluation (P = 0.000); Mean TLK before operation was 39°, and 7.1° at the final postoperative evaluation (P = 0.000); Mean NRS before operation was 4.7, compared with 0.9 at the final postoperative evaluation (P = 0.000). In group B: Mean preoperative SVA was 62.5 mm and decreases to 30.7 mm at the final postoperative evaluation (P = 0.000); Mean TLK before operation was 33°, and 9.7° 2 years post-operation (P = 0.000); Mean NRS prior to surgery was 4.0, and 0.8 at the last follow-up evaluation (P = 0.000). The improvement of the NRS scores of groups A and B was related to the improvement of the cobb angle (P = 0.020); (P = 0.009) respectively. Conclusion In the treatment of Kümmell’s disease with thoracolumbar kyphosis,to restore the normal alignment and sagittal balance can obtain a satisfactory radiographic and clinical short and medium-term effects.

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Section: Discussionsupporting

confidence: 94%

Radiographic and clinical outcomes of surgical treatment of Kümmell’s disease with thoracolumbar kyphosis: a minimal two-year follow-up

Cheng

Wang

et al. 2021

BMC Musculoskelet Disord

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“…Previous studies have reported a distinct association between the development of ASD and postoperative vertebral mechanical alterations [ 10 ]. In the last decade, restoring the sagittal balance of spinopelvic has become a therapeutic goal of lumbosacral surgery, with increasing attention being paid by surgeons to its impact on long-term postoperative outcomes, both radiologically and symptomatic ASD [ 12 , 13 ]. Natural language processing allows convenient screening of big data, and we rely on this technique to achieve intelligent medical diagnosis for medical record review and human-machine interaction from EMS [ 14 – 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…The study from Chaleat-Valayer and others indicated that chronic low back pain was more common in patients with low SS, low LL, and small PI [ 34 ]. He and colleagues reported a specific pattern of sagittal spinopelvic alignment that is associated with symptomatic ASD, including SL and PT [ 13 ]. In this study, in addition to postoperative DA, postoperative PT was another key indicator of symptomatic ASD, with worse improvement in PT in the symptomatic ASD group.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors for Adjacent Segment Degeneration after Minimally Invasive Transforaminal Interbody Fusion at Lumbosacral Spine

Dong

Jia

et al. 2022

Computational Intelligence and Neuroscience

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Background. Adjacent segment degeneration (ASD) has been considered as a serious complication from changes in the biological stress pattern after spinal fusion. The sagittal balance significantly associated with lumbar loading is largely dependent on L5-S1 segment. However, the evidence indicating risk factors for radiological and symptomatic ASD after minimally invasive transforaminal interbody fusion (MIS-TLIF) remains insufficient. Methods. This single-central retrospective study recruited patients with lumbosacral degeneration receiving MIS-TLIF at the L5-S1 level from January 2015 to December 2018. The targeted variables included demographic information, radiological indicators, surgery-related parameters, and patient-reported outcomes (PROs) extracted from the electronic medical system by natural language processing. In these patients, a minimum of 3-year follow-up was done. After reviewing the preoperative and postoperative follow-up digital radiographs, patients were assigned to radiological ASD group (disc height narrowing ≥3 mm, progressive slipping ≥3 mm, angular motion >10°, and osteophyte formation >3 mm), symptomatic ASD group, and control group. We identified potential predictors for radiological and symptomatic ASD with the service of stepwise logistic regression analysis. Results. Among the 157 consecutive patients treated with MIS-TLIF in our department, 16 cases (10.2%) were diagnosed with radiological ASD at 3-year follow-up. The clinical evaluation did not reveal suspicious risk factors, but several significant differences were confirmed in radiological indicators. Multivariate logistic regression analysis showed postoperative PI, postoperative DA, and ∆PI-LL in radiological ASD group were significantly different from those in control group. Nevertheless, for patients diagnosed with simultaneously radiological and symptomatic ASD, postoperative DA and postoperative PT as risk factors significantly affected the clinical outcome following MIS-TLIF. Conclusion. In this study, while approximately 10% of lumbosacral degenerations develop radiographic ASD, prognosis-related symptomatic ASD was shown not to be a frequent postoperative complication. Postoperative PI, postoperative DA, and mismatched PI-LL are risk factors for radiological ASD, and postoperative DA and postoperative PT are responsible for the occurrence of symptomatic ASD following MIS-TLIF. These radiological risk factors demonstrate that restoration of normal sagittal balance is an effective measure to optimize treatment strategies for secondary ASD prevention.

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“…Takahashi et al [21] found that the insu cient increase of L3-L5 SL in the treatment of L3 and L4 double-segment degenerative spondylolisthesis by PLIF was related to the poor clinical prognosis. He et al [22] believe that in the treatment of degenerative spondylolisthesis with PLIF, the recovery of SL and PT is related to the clinical effect, and the increase of SL and the decrease of PT may play a positive role in relieving low back pain after operation. In this study, Δ L4-S1 SL, L4-S1 SL in group G was higher than that in group P, and positively correlated with the improvement rate of JOA score, indicating the importance of reconstruction of L4-S1 SL in double-segmental spondylolisthesis for improving clinical prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…In order to reconstruct L4-S1 SL, we think the following can be done during the operation: 1. the hip joint should be properly extended before operation; 2. the posterior hyperplastic structures should be removed completely, which is bene cial to the shortening of the rear and the opening of the front during compression; 3. a moderate-sized cage should be anterior placed within disc space [22,24,25]; 4. in order to avoid the di culty of compression, the anterior part of disc space can be grafted rst, and then the remaining bone can be implanted after compression; 5. the ideal range of L4 -S1 SL is 2/3 of LL, and LL is related to PI [11,26,27], so individual bending should be performed; 5. L4 and L5 screws toward the lower endplate is more bene cial to the compression and the recovery of segmental lordosis [28].…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of PLIF in Restoring L4-S1 Segmental Lordosis of 2-level Isthmic Spondylolisthesis

Wang¹,

Liu²,

Jing³

et al. 2021

Preprint

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Background: Spinal and pelvic sagittal plane balance is closely related to good clinical prognosis, so in the treatment of 2-level isthmic spondylolisthesis, attention should be paid not only to adequate nerve decompression, but also to the correction of lumbosacral sagittal plane parameters. The purpose of this study was to observe the clinical prognosis and sagittal parameters of patients with isthmic spondylolisthesis treated with PLIF, and to find out the risk factors leading to poor prognosis. Methods: From January 2006 to August 2018, the clinical data of patients with 2-level isthmic spondylolisthesis treated with PLIF in the Second Xiangya Hospital of Central South University were retrospectively collected. The clinical symptoms (JOA score and VAS score) and the sagittal parameters of lumbosacral segment (PI, PT, LL, L4-S1 SL, LDI, PI-LL, LL and L4-S1 SL) were recorded before operation, immediately after operation and at the last follow-up. According to the improvement rate of JOA score, the patients were divided into two subgroups, poor(P) group and good(G) group. The parameters within and between the two subgroups were compared. Meanwhile, Pearson correlation analysis was conducted between sagittal parameters and JOA score improvement rate.Results: A total of 52 patients were enrolled in this study, the average age was (59.96 ±9.11) years, and the mean follow-up time was (31.88 ±8.37) months. Group G (n = 37) and group P (n = 15). In terms of clinical symptom improvement and sagittal plane parameters, except PI, the other parameters of the patients were improved compared with those before operation, and the difference was statistically significant. In the intra-group comparison, except PI, other indexes in group G were significantly improved, while in group P, there was no significant difference in PI, LL, L4-S1 SL, LDI, PI-LL before and after operation. In the comparison between groups, there was no significant difference in baseline data between group G and group P; postoperative VAS score(back pain) in group G was lower than that in group P, but there was no significant difference in VAS score( leg pain); in terms of JOA score and JOA score improvement rate, group G was significantly better; △L4-S1 SL ,L4-S1 SL and LDI were larger in group G, and the proportion of patients with normal LDI was higher than that in group P. Pearson correlation analysis showed that postoperative △L4-S1 SL, LDI and L4-S1 SL were positively correlated with JOA improvement rate. 2 patients with failed internal fixation occurred in group P, and the postoperative LDI was less than 50%. Conclusion: PLIF is an effective method for the treatment of 2-level isthmic spondylolisthesis. ΔL4-S1 SL, L4-S1 SL and good LDI may be important sagittal parameters affecting the clinical prognosis of L4 and L5 isthmus spondylolisthesis.

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Analysis of Spinopelvic Sagittal Balance and Persistent Low Back Pain (PLBP) for Degenerative Spondylolisthesis (DS) following Posterior Lumbar Interbody Fusion (PLIF)

Cited by 18 publications

References 31 publications

Radiographic and clinical outcomes of surgical treatment of Kümmell’s disease with thoracolumbar kyphosis: a minimal two-year follow-up

Radiographic and clinical outcomes of surgical treatment of Kümmell’s disease with thoracolumbar kyphosis: a minimal two-year follow-up

Analysis of Risk Factors for Adjacent Segment Degeneration after Minimally Invasive Transforaminal Interbody Fusion at Lumbosacral Spine

Clinical Significance of PLIF in Restoring L4-S1 Segmental Lordosis of 2-level Isthmic Spondylolisthesis

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