Clinical outcome after lumbar spinal fusion surgery in degenerative spondylolisthesis: a 3-year follow-up

Abstract

Introduction Lumbar spinal fusion surgery is a widely accepted surgical treatment in degenerative causes of lumbar spondylolisthesis. The benefit of reduction of anterior displacement and restoration of sagittal parameters is still controversially debated. Purpose of the underlying publication was to analyze the influence of radiographic sagittal parameters of the spine in aspects of changes in postoperative clinical outcome. Materials and methods By prospective analysis, we included patients with low-grade degenerative lumbar spondylolisthesis (Meyerding grades I and II) with mono- or bisegmental fusion surgery with a minimum follow-up data of 3 years. For clinical outcome measures, COMI, ODI and EQ-5D were used. Spinopelvic parameters (sacral inclination, pelvic tilt, sacral slope and pelvic incidence, lumbar lordosis and lumbar index as well as anterior displacement and sagittal rotation) were measured on plain radiographs. Results We could observe a significant benefit in clinical outcome after lumbar fusion surgery in low-grade spondylolisthesis in our mid-term follow-up data including 32 patients. By surgical reduction, we could see significant restoration of anterior displacement and sagittal rotation. Interestingly, a significant correlation between restoration of both sagittal rotation and sacral inclination and clinical outcome score was observed in the 3-year follow-up. Conclusion In low-grade spondylolisthesis, spinal fusion surgery is a well-established surgical procedure; however, the impact of sagittal parameters and reduction of anterior displacement remains controversial. Within our findings, restoration of sagittal parameters showed significant correlation to improvement in clinical outcome in our mid-term follow-up data.

Comparison between posterior lumbar interbody fusion and transforaminal lumbar interbody fusion in the management of lumbar spondylolisthesis

“…Liu et al found comparable short-term functional results in 226 patients undergoing TLIF and PLIF procedures (3). Lenz et al reported on their three-year observation of the clinical outcome after lumbar spinal fusion surgery for DLS (9). The authors confi rmed signifi cant benefi ts in patients after surgery; moreover, they showed a considerable restoration of anterior displacement and sagittal rotation.…”

“…These clinical symptoms have to correlate with radiological fi ndings on Xray and MRI. The surgical treatment aims to stabilize, reduce the displaced vertebra (return to position), decompress and remove nerve compression (9,10).…”

Long‐term Radiological and Clinical Outcome after Lumbar Spinal Fusion Surgery in Patients with Degenerative Spondylolisthesis: A Prospective 6‐Year Follow‐up Study

“…and Boxall et al . 21 , 25 Figure 1 illustrates how the gliding angle, and the sagittal rotation were defined and measured. The grade of spondylolisthesis was defined by the Meyerding classification.…”

“…Two different orthopedic surgeons measured the spinopelvic parameters including sacral slope, sacral inclination, pelvic tilt, pelvic incidence, lumbar lordosis, gliding angle, sagittal rotation and the percentage of anterior displacement of the vertebral body as described by Lenz et al . and Boxall et al 21,25 . Figure 1 illustrates how the gliding angle, and the sagittal rotation were defined and measured.…”

“…In terms of the long‐term outcome, radiographic outcome parameters are not clearly connected with clinical outcome parameters yet 15–20 . Recently published results of 3‐year follow‐up outcome data of patients suffering from degenerative spondylolisthesis who underwent lumbar spinal fusion surgery showed that reduction of the sagittal rotation and the sacral inclination correlates with an improvement of clinical outcome scores collected by the Core Outcome Measure Index (COMI) and the Oswestry Disability Index (ODI) 21 …”