Does restoration of focal lumbar lordosis for single level degenerative spondylolisthesis result in better patient-reported clinical outcomes? A systematic literature review

Rhee, Chanseok; Visintini, Sarah; Dunning, Cynthia E.; Oxner, William; Glennie, R. Andrew

doi:10.1016/j.jocn.2017.06.039

Cited by 22 publications

(20 citation statements)

References 34 publications

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“…Additionally, the increase in segmental lordotic restoration in this study compares favorably to a weighted average increase of 3.9° published in a review by Uribe et al 43 Despite these positive findings, it is important to note that the question whether improvement in LL translates into actual improved clinical outcomes for treatment of spondylolisthesis has not been reliably answered in the literature. 31 The same can also be said for height restoration, which was also improved in this study, but is unproven regarding clinical efficacy.…”

Section: Key Resultssupporting

confidence: 53%

“…Although this finding is encouraging, a recent systematic review did not find sufficient support for this in the literature. 31 One of the , who studied MIS TLIF with or without the use of reduction, no significant improvement in ODI or NRS back or leg pain was associated with the degree of reduction in spondylolisthesis in our patients. 8 In this study, improvements in back disability on average surpassed the published minimum clinically important difference for ODI 27 and demonstrated a durable reduction throughout the duration of follow-up.…”

Section: Key Resultsmentioning

confidence: 46%

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Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis

Massie¹,

Zakaria²,

Schultz

et al. 2018

Neurosurgical Focus

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OBJECTIVEThe inability to significantly improve sagittal parameters has been a limitation of minimally invasive surgery for transforaminal lumbar interbody fusion (MIS TLIF). Traditional cages have a limited capacity to restore lordosis. This study evaluates the use of a crescent-shaped articulating expandable cage (Altera) for MIS TLIF.METHODSThis is a retrospective review of 1- and 2-level MIS TLIF. Radiographic outcomes included differences in segmental and lumbar lordosis, disc height, evidence of fusion, and any endplate violations. Clinical outcomes included the numeric rating scale for leg and back pain and the Oswestry Disability Index (ODI) for low-back pain.RESULTSThirty-nine patients underwent single-level MIS TLIF, and 5 underwent 2-level MIS TLIF. The mean age was 63.1 years, with 64% women. On average, spondylolisthesis was corrected by 4.3 mm (preoperative = 6.69 mm, postoperative = 2.39 mm, p < 0.001), the segmental angle was improved by 4.94° (preoperative = 5.63°, postoperative = 10.58°, p < 0.001), and segmental height increased by 3.1 mm (preoperative = 5.09 mm, postoperative = 8.19 mm, p < 0.001). At 90 days after surgery the authors observed the following: a smaller postoperative sagittal vertical axis was associated with larger changes in back pain at 90 days (r = −0.558, p = 0.013); a larger decrease in spondylolisthesis was associated with greater improvements in ODI and back pain scores (r = −0.425, p = 0.043, and r = −0.43, p = 0.031, respectively); and a larger decrease in pelvic tilt (PT) was associated with greater improvements in back pain (r = −0.548, p = 0.043). For the 1-year PROs, the relationship between the change in PT and changes in ODI and numeric rating scale back pain were significant (r = 0.612, p = 0.009, and r = −0.803, p = 0.001, respectively) with larger decreases in PT associated with larger improvements in ODI and back pain. Overall for this study there was a 96% fusion rate.Fourteen patients were noted to have endplate violation on intraoperative fluoroscopy during placement of the cage. Only 3 of these had progression of their subsidence, with an overall subsidence rate of 6% (3 of 49) visible on postoperative CT.CONCLUSIONSThe use of this expandable, articulating, lordotic, or hyperlordotic interbody cage for MIS TLIF provides a significant restoration of segmental height and segmental lordosis, with associated improvements in sagittal balance parameters. Patients treated with this technique had acceptable levels of fusion and significant reductions in pain and disability.

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Section: Key Resultssupporting

confidence: 53%

Section: Key Resultsmentioning

confidence: 46%

Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis

Massie¹,

Zakaria²,

Schultz

et al. 2018

Neurosurgical Focus

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“…In a systematic review investigating the effect of restoring LL on PROMs in single-level DS, the authors concluded that correction of focal lordosis for single-level lumbar DS did not affect PROMs. [ 22 ] Similar results were found in a study examining 2-level lumbar DS, which found correction of focal lordosis and LL had no impact on the postoperative Japanese Orthopaedic Association score. [ 23 ] One likely explanation for this finding is that the sagittal malalignment produced from a 1-or 2-level DS is relatively small compared to the normal amount of lordosis present in the lower lumbar spine.…”

Section: Discussionsupporting

confidence: 75%

Does change in focal lordosis after spinal fusion affect clinical outcomes in degenerative spondylolisthesis?

Karamian

DiMaria

Lambrechts

et al. 2022

J Craniovert Jun Spine

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Study Design: Retrospective cohort study. Objective: The objective of this study is to determine the effect of focal lordosis and global alignment and proportion (GAP) scores on patient reported outcome measures (PROMs) after posterior lumbar fusion for patients with 1- or 2-level lumbar degenerative spondylolisthesis (DS). Summary of Background Data: In patients with DS, improvements in spinopelvic parameters are believed to improve clinical outcomes. However, the effect of changing focal lordosis in patients with 1-or 2-level degenerative lumbar spondylolisthesis is unclear. Materials and Methods: Postoperative spinopelvic parameters and perioperative focal lordosis changes were measured for 162 patients at a single academic center from January 2013 to December 2017. Patients were divided into three groups: >2° (lordotic group), between 2° and −2° (neutral group), and −2°° (kyphotic group). Patients were then reclassified based on GAP scores. Recovery ratios (RR) and the number of patients achieving the minimal clinically important difference (MCID) were calculated for PROMs. Standard descriptive statistics were reported for patient demographics and outcomes data. Multiple linear regression analysis controlled for confounders. Alpha was set at P < 0.05. Results: There was no significant association between change in focal lordosis and surgical complications including adjacent segment disease ( P = 0.282), instrumentation failure ( P = 0.196), pseudarthrosis ( P = 0.623), or revision surgery ( P = 0.424). In addition, the only PROM affected by change in focal lordosis was Mental Component Scores (ΔMCS-12) (lordotic = 2.5, neutral = 8.54, and kyphotic = 5.96, P = 0.017) and RR for MCS-12 (lordotic = 0.02, neutral = 0.14, kyphotic 0.10, P = 0.008). Linear regression analysis demonstrated focal lordosis was a predictor of decreased improvement in MCS-12 (β = −6.45 [−11.03- −1.83], P = 0.007). GAP scores suggested patients who were correctly proportioned had worse MCID compared to moderately disproportioned and severely disproportioned patients ( P = 0.024). Conclusions: The change in focal lordosis not a significant predictor of change in PROMs for disability, pain, or physical function. Proportioned patients based on the GAP score had worse MCID for Oswestry Disability Index. Level of Evidence: III

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“…Barrey et al found one-and two-level lumbar spondylolisthesis to correlate with greater positive SSPA and pelvic retroversion [50]. Rhee et al did not observe a connection between clinical improvement and changes in LL or overall sagittal imbalance after treated lumbar spondylolisthesis [51]. Similar findings have been reported by Försth et al when comparing fusion surgery with decompression alone in LSS [52].…”

Section: Discussionmentioning

confidence: 61%

Effect of lumbar laminectomy on spinal sagittal alignment: a systematic review

et al. 2021

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Purpose Positive spinal sagittal alignment is known to correlate with pain and disability. The association between lumbar spinal stenosis and spinal sagittal alignment is less known, as is the effect of lumbar decompressive surgery on the change in that alignment. The objective was to study the evidence on the effect of lumbar decompressive surgery on sagittal spinopelvic alignment. Methods The Cochrane Controlled Trials Register (CENTRAL), Medline, Embase, Scopus and Web of Science databases were searched in October 2019, unrestricted by date of publication. The study selection was performed by two independent reviewers. The risk of systematic bias was assessed according to the NIH Quality Assessment Tool. The data were extracted using a pre-defined standardized form. Results The search resulted in 807 records. Of these, 18 were considered relevant for the qualitative analysis and 15 for the meta-synthesis. The sample size varied from 21 to 89 and the average age was around 70 years. Decompression was mostly performed on one or two levels and the surgical techniques varied widely. The pooled effect sizes were most statistically significant but small. For lumbar lordosis, the effect size was 3.0 (95% CI 2.2 to 3.7) degrees. Respectively, for pelvic tilt and sagittal vertical axis, the effect sizes were − 1.6 (95% CI .2.6 to − 0.5) degrees and − 9.6 (95% CI − 16.0 to − 3.3) mm. Conclusions It appears that decompression may have a small, statistically significant but probably clinically insignificant effect on lumbar lordosis, sagittal vertical axis and pelvic tilt.

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Does restoration of focal lumbar lordosis for single level degenerative spondylolisthesis result in better patient-reported clinical outcomes? A systematic literature review

Cited by 22 publications

References 34 publications

Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis

Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis

Does change in focal lordosis after spinal fusion affect clinical outcomes in degenerative spondylolisthesis?

Effect of lumbar laminectomy on spinal sagittal alignment: a systematic review

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