Effects of preoperative sagittal spinal imbalance on pain after lateral lumbar interbody fusion

Abstract

Sagittal misalignment has been associated with negative quality of life (QOL). However, there is no report on whether differences in preoperative sagittal misalignment in patients with lumbar degenerative diseases affect postoperative results after lateral lumbar interbody fusion (LLIF). We investigated whether preoperative sagittal alignment influences the correction of alignment after surgery and whether the preoperative sagittal alignment affects the rating of low back pain, leg pain, and leg numbness. The subjects were 81 patients (48 male, 33 females, average age at surgery 70.2 years) who underwent anterior–posterior combined surgery with LLIF and percutaneous pedicle screws from May 2018 to July 2020. Cluster analysis was performed using the preoperative sagittal vertical axis (SVA) value, and patients were classified into two groups (group 1; n = 30, SVA = 129.0 ± 53.4 mm, group 2; n = 51, SVA = 30.8 ± 23.5 mm). Baseline demographics and treatment data were compared between groups. Sagittal and pelvic parameters and pain scores, such as low back pain, leg pain, and leg numbness, were also compared. Operative time, blood loss, and length of hospital stay did not differ significantly between groups. The changes (Δ) in SVA and lumbar lordosis (LL) for all patients from before to after surgery were not significant (ΔSVA; p = 0.218, ΔLL; p = 0.189, respectively). The SVA, LL, and PI − LL changed significantly after the surgery in group 1, but no marked improvement in sagittal imbalance was obtained after LLIF surgery. The improvement in each pain score from before to after the surgery did not differ significantly between groups. LLIF surgery has a limited chance of recovering sagittal imbalance. However, postoperative low back pain, leg pain, and leg numbness may be improved by LLIF surgery, regardless of the preoperative sagittal alignment.

Incidence of surgical site infection following lateral lumbar interbody fusion compared with posterior/transforminal lumbar interbody fusion: A propensity score-weighted study

“…However, the mean length of stay in our study was around 20 days, which likely improved the accuracy of the outcome evaluation. Although this mean length of stay is much longer than in Western countries,21,50 it is consistent with other work from Japan 29,51. In addition, a sensitivity analysis, in which we extended the term of SSI from 30 to 90 days after surgery showed consistent results.…”

“…Although this mean length of stay is much longer than in Western countries, 21,50 it is consistent with other work from Japan. 29,51 In addition, a sensitivity analysis, in which we extended the term of SSI from 30 to 90 days after surgery showed consistent results. Thus, we do not consider that this limitation should overturn our findings.…”

Analysis of intervertebral disc CCR6 and IL‐6 gene levels with short‐term postoperative low back pain after spinal fusion in lumbar degenerative disease

“…Various reports have been published on postoperative pain. 16 , 17 , 18 At present, factors affecting patients' postoperative pain can be broadly grouped into categories of sex, 19 obesity, 20 preoperative opioid abuse, 21 preoperative chronic pain, 22 and many other factors. Molecular analysis of the factors involved in post‐spine surgery pain may lead to new treatment methods.…”

Risk Factors in the Prediction of Leg Numbness after Spinal Endoscopic Surgery: Evaluation and Development of a Nomogram

“…After restoring the height of the intervertebral space, the volume of the intervertebral foramen increased by 39.6%, resolving the leg numbness caused by nerve root compression [ 23 ]. In addition, spinal sagittal imbalance caused by degenerative scoliosis also caused leg numbness and PI-LL was found to be significantly positively correlated with SVA ( r = 0.647, P < 0.001) [ 24 ]. The study of Aoki et al also found that PI-LL was significantly correlated with the occurrence of leg numbness after spinal endoscopy, which indicated that PI-LL mismatch would affect the symptoms of leg numbness after surgery [ 25 ].…”