Influence of pelvic incidence-lumbar lordosis mismatch on surgical outcomes of short-segment transforaminal lumbar interbody fusion

Abstract

BackgroundThe importance of pelvic incidence-lumbar lordosis (PI-LL: PI minus LL) mismatch is emphasized in long-segment fusion for adult spinal deformity; however, there are few studies evaluating the influence of PI-LL on surgical outcomes after short-segment fusion. In this study, we have examined the effects of PI-LL mismatch on surgical outcomes of short-segment lumbar intervertebral fusion for lumbar degenerative diseases.MethodsPatients with lumbar degenerative disease treated by short-segment (1 or 2 levels) transforaminal lumbar interbody fusion were divided into Group A (PI-LL ≤ 10°: n = 22) and Group B (PI-LL ≥ 11°: n = 30). Pre-and post-operative patient symptoms were assessed by the visual analogue scale (VAS: scores 0-100 mm; for LBP, lower-extremity pain, and lower-extremity numbness), a detailed VAS for LBP while in motion, standing, and sitting, and the Oswestry disability index (ODI). Surgical outcomes were evaluated by the Nakai score (3 = excellent to 0 = poor. Post-operative data were acquired for at least one year following surgery and were compared between the two groups. Multiple regression analyses were used to evaluate the relative influence of PI-LL on each pre-and post-operative parameter (VAS, detailed VAS and ODI) adjusted for age, sex, fusion levels, body mass index, presence of scoliosis, diabetes mellitus and depression.ResultsThe surgical outcomes in Group A were significantly better than those of Group B. Group A showed better post-operative VAS scores for LBP, particularly LBP while standing (11.9 vs. 25.8). The results of the multivariate analyses showed no significant correlation between PI-LL and pre-operative symptoms, but did show a significant correlation between PI-LL and the post-operative VAS score for LBP, lower extremity pain, and numbness.ConclusionsThis study is the first to find that PI-LL mismatch influences post-operative residual symptoms, such as LBP, lower extremity pain and numbness. Among the three types of LBP examined in the detailed VAS, LBP while standing was most strongly related to PI-LL mismatch. The importance of maintaining spinopelvic alignment is emphasized, particularly when treating patients with adult spinal deformity using long-segment fusion surgery. However, our results indicate that surgeons should pay attention to sagittal spinopelvic alignment and avoid post-operative PI-LL mismatch even when treating patients with short-segment lumbar interbody fusion.

A Preliminary Study on the Correlation Between Spinopelvic Parameters and Balance in Ankylosing Spondylitis

“…Since pelvic incidence is set by adulthood, corrective surgeries should be planned on achieving the appropriate lumbar lordosis. 11 It has been reported that patients with AS had lower pelvic incidence, lumbar lordosis, sacral slope and higher pelvic tilt and sagittal vertical axis when compared to healthy controls. 7,12 Sagittal vertical axis, lumbar lordosis and sacral slope were suggested as predictive factors for the clinical outcomes in AS.…”

Minimally invasive transforaminal lumbar interbody fusion with expandable versus static interbody devices: radiographic assessment of sagittal segmental and pelvic parameters

“…8,10 For deformity surgery, restoring pelvic incidence-lumbar lordosis mismatch to less than 10° had a great impact on improving clinical performance scores. 1,16,19 Little is known about the effects of MIS-TLIF with expandable interbody devices on pelvic parameter measurements assessed on lateral radiographs. In light of this, we performed a retrospective review to evaluate the effects of MIS-TLIF with expandable versus static interbody devices on disc height, foraminal height, index-level segmental lordosis, lumbar lordosis, and pelvic parameters.…”

A comparative analysis of the prevalence and characteristics of cervical malalignment in adults presenting with thoracolumbar spine deformity based on variations in treatment approach over 2 years

“…Op CD-1Y patients also showed greater T1S-CL deformity compared to the NonOp group (74.4 %), and there was a worsening of T1S-CL mismatch from baseline to 1-year post-operative among Op CD-1Y patients (24.35°-31.41°). As PI-LL mismatch has been previously reported to influence post-operative residual symptoms, it is possible that abnormal T1S-CL could represent a similar degenerative process in the cervicothoracic junction and marker for overall deformity and imbalance [21]. T1S-CL mismatch has also been correlated with inferior patient-reported outcomes by Lee et al, an observation which is sustained in this report [9].…”