Effect of Sagittal Balance on Risk of Falling after Lateral Lumbar Interbody Fusion Surgery Combined with Posterior Surgery

Abstract

PurposeTo demonstrate the impact of correcting sagittal balance (SB) on functional outcomes of surgical treatment for degenerative spinal disease and actual falls via utilization of new minimally invasive lumbar fusion techniques via a lateral approach.Materials and MethodsFrom November 2011 to March 2015, we enrolled 56 patients who underwent minimally invasive lateral lumbar interbody fusion (LLIF) and matched 112 patients receiving decompression/postero-lateral fusion (PLF) surgery for lumbar spinal stenosis. According to SB status using C7-plumb line-distance (C7PL) and surgery type, patients were divided into three groups: SB PLF, sagittal imbalance (SI) PLF, and LLIF groups. We then compared their outcomes.ResultsThe mean C7PL was 6.2±13.6 mm in the SB PLF group, 72.9±33.8 mm in the SI PLF group, and 74.8±38.2 mm in the LLIF group preoperatively. Postoperatively, C7PL in only the LLIF group improved significantly (p=0.000). Patients in the LLIF group showed greater improvement in fall-related functional test scores than the SI PLF group (p=0.007 for Alternate-Step test, p=0.032 for Sit-to-Stand test). The average number of postoperative falls was 0.4±0.7 in the SB PLF group, 1.1±1.4 in the SI PLF group, and 0.8±1.0 in the LLIF group (p=0.041). Oswestry Disability Index and the Euro-QoL 5 dimension visual analogue scale scores also showed greater improvements in the LLIF group than in the SI PLF group at postoperative 1 year (p=0.003, 0.016).ConclusionSurgical correction of SI in patients with lumbar spinal stenosis using a combination of minimal invasive LLIF and posterior surgery achieved better surgical outcomes and a lower incidence of actual falls than PLF surgery.

Llif in the Correction of Degenerative Scoliosis in Elderly Patients

“…The analysis of available literature data and the results of our study suggest that deformity correction by standard open surgery via a posterior approach (Table 3 28,29,30 ) and LLIF in combination with MIS transpedicular screws (Table 3 14,17,36,42 ) provided similar correction in terms of LL, PT, PI-LL and Cobb angle.…”

“…[28][29][30] Standard open methods of surgical correction of ADS may also be associated with a higher incidence of infection, failure of the fixation, and junctional kyphosis, which can lead to a poor outcome. 31,32 In recent years, minimally invasive surgery in combination with short-segment fixation of the spine has been used for the treatment of this group of patients [33][34][35][36] (Table 2). Clinical and radiological outcomes of minimally invasive and open surgery have shown similar results.…”

“…26,[28][29][30][43][44][45][46] The use of LLIF technology in the surgical treatment of ADS is accompanied by greatly reduced intraoperative blood loss. 36 168 LLIF Anand et al 33 28 LLIF + TPF 241 53.5 25.9 Diaz et al 34 39 When using the LLIF technique in adult deformity surgery, the concept of minimally invasive surgery is used: skin incision is smaller and there is less soft tissue trauma, smaller bone defect, lack of contact with dura mater and reduced retractive soft tissue injuries which significantly decreases the rate of wound infection, volume of blood loss and duration of hospital stay. The interbody implant used has a large contact area in comparison with other implants and is based on the dense part of the end plate, thereby creating greater support for the anterior column while maintaining middle and posterior column support to the spine.…”

Lumbar Spinal Stenosis: Pathophysiology and Treatment Principle: A Narrative Review

“…When fusion is performed, it is important to consider sagittal balance as achieving sagittal balance after surgery can result in good surgical outcomes and also help reduce the risk of fall after surgery [ 38 , 39 ]. Studies have reported that the recent emergence of surgical techniques using minimally invasive spine surgery, including endoscopic decompression, has led to better results in terms of length of hospital stay, blood loss, cost, and postoperative outcome than the existing surgical methods [ 36 , 40 - 43 ].…”

A UK-based pilot study of current surgical practice and implant preferences in lumbar fusion surgery

“…[ 7 ] Indications for XLIF combined with posterior fixation include lumbar spinal stenosis and adjacent segment disease. [ 29 , 30 ] Another posterior fusion approach is TLIF, which was proposed to reduce the extent of neural retraction required during the traditional PLIF approach. Accordingly, TLIF has been associated with less blood loss and reduced risk of injury to the neural and vascular structures, as well as shorter operating time.…”