Influence of the Sagittal Balance on the Clinical Outcome in Spinal Fusion

Coutinho, Marcela Almeida Campos; Pratali, Raphael de Rezende; Motta, Marcel Machado da; Hoffman, Carla Balkanyi; Barsotti, Carlos Eduardo Gonçales; Santos, Francisco Prado Eugenio dos; Oliveira, Carlos Eduardo Algaves Soares de

doi:10.1590/s1808-185120161501153517

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…The spinopelvic morphology modulates the lumbosacral configuration and consequently, the mechanical stress at the lumbosacral junction. Restoration of the sagittal balance has been emphasized recently (33,54) and it has been shown to directly impact both the standing balance and clinical outcomes of the patients (54,55). Kawakami et al (56) studied whether lumbar sagittal balance affected the clinical outcome after PLF and they concluded that SVA (center in the L1 to the back corner of the S1) should be considered in the choice of treatment strategy when PLF is indicated for patients with degenerative lumbar spondylolisthesis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion in Patients with Lumbar Spinal Stenosis and Degenerative Instability

et al. 2018

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Background: Degenerative lumbar spine disease can lead to lumbar spine instability. Lumbar spine instability is defined as an abnormal response to applied loads characterized kinematically by abnormal movement in the motion segment beyond normal constraints. Patients with lumbar spinal stenosis (LSS) typically present with low back pain (LBP), cramping, cauda equine syndrome, and signs of nerve root compression associated by weakness, numbness and tingling in their legs that are worsened with standing and walking. This degenerative condition severely restricts function, walking ability, and quality of life (QOL). Objectives: This study aims to compare clinical and radiological outcomes of posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF) with posterior instrumentation in the treatment of LSS and degenerative instability. Study Design: A randomized, prospective, controlled clinical study. Methods: In this prospective study, 88 patients with LSS and degenerative instability were randomly allocated to one of 2 groups: PLF (Group I) or PLIF (Group II). Primary outcomes were the control of LBP and radicular pain, evaluated with visual analog scale (VAS), the improvement of QOL assessed by the Oswestry disability index (ODI) scale, and measurement of fusion rate, Cobb angle, spinal sagittal balance, and modic changes in the 2 groups. Results: At 24 months postoperatively, the mean reduction in VAS scores in Group I was more than in Group II (5.67 vs. 5.48, respectively) and the patients in Group I had more improvement in the ODI score than the patients in Group II (42.75 vs. 40.94, respectively). There was a statistically significant difference between the preoperative and postoperative sagittal balance in the 2 groups. The mean Cobb angle changed significantly in the 2 groups. Limitations: There are few prospective studies of PLIF or PLF in patients with LSS and degenerative lumbar spine instability, and a limited number of studies which exists have examined the safety and outcome of each procedure without comparing it with other fusion techniques. Because most of the studies in the literature have been conducted in the patients with IS, we could not compare and contrast our findings with studies in patients with LSS and degenerative lumbar spine instability. In addition, although in our study the findings at a 24-month follow-up period showed that PLF was better than PLIF in these patients, there were some studies in which the authors reported that PLIF showed better clinical results than PLF at a 48-month followup period. So we suggest that rigorous controlled trials at longer follow-up periods should be undertaken in groups of patients with LSS and degenerative lumbar spine instability who undergo posterior decompression and instrumented fusion to help to determine the ultimate best fusion technique for these patients. Conclusion: PLF with posterior instrumentation provides better clinical outcomes and improvement in the LBP, radicular pain, and functional QOL, more correction of the Cobb angle, more restoration of sagittal alignment, more decrease in Modic type 1, and more increase in Modic type 0, despite the low fusion rate compared to PLIF. Key words: Lumbar spinal stenosis, degenerative instability, posterolateral fusion, posterior lumbar interbody fusion, low back pain, quality of life, cobb angle, fusion rate, mobic changes, sagittal balance

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion in Patients with Lumbar Spinal Stenosis and Degenerative Instability

et al. 2018

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“…The published studies on functional outcome and SPA after spinal surgery have offered conflicting results. A number of studies have established a significant relationship between these parameters and outcomes, while others were unable to establish a relationship, even with positive outcomes, while these measurements were abnormal [2,3,7,10,12,[14][15][16]. This inconsistency may be due to other factors contributing to the outcome not being studied or due to the short follow-up procedures.…”

Section: Discussionmentioning

confidence: 99%

How Do Pelvic Parameters Correlate With Postoperative Outcomes When the Parameters Are Not Measured Preoperatively in Patients Undergoing Instrumented Lumbar Fusion?

Fallatah¹,

Altijani²,

Alharbi³

et al. 2021

Cureus

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Objective: A normal age-adjusted sagittal alignment is an important factor in achieving long-term functional results after lumbar spinal fusion. We aim to determine if the changes in spino-pelvic alignment (SPA) correlate with post-operative functional outcomes in patients who underwent instrumented lumbar spine surgery when the parameters were not measured before.Method: A retrospective review of medical records from 2012 to 2016, and radiographs of the patients who underwent instrumented fusion of the lumbar spine. The X-rays of the available preoperative lumbar spine were reviewed for SPA and compared with the last follow-up postoperative images. The patients were contacted by telephone to complete the EuroQoL 5 Dimensions 5-level questionnaire and visual analog scale for evaluation of their functional outcomes during 2017. Correlation studies were performed using Pearson's coefficient.Results: Forty-six patients were included with a mean age of 53 years and a follow-up of 47 months. There was a significant improvement in the functional outcomes and pain in the whole group. All the patients showed improvement in their SPA, and those who underwent more than two levels of fusion showed a significant improvement (P<0.05). Lumbar lordosis and sacral slope had a significant correlation with postoperative clinical improvement (R=0.8). Conclusion:The study showed that single or double fusion has significant improvement in pain and functional outcome with a significant change in SPA.

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“…The spino-pelvic parameters are key components in the evaluation and treatment of sagittal deformities 9 and also of degenerative pathologies of the spine, as correct sagittal alignment directly impacts the quality of life of these patients. 13,14 The current standard for acquiring the measurements uses manual measuring of these parameters with a goniometer, a process that requires a dermatograph pencil for drawing lines on the radiographic film, as well as the goniometer itself, which the clinician many times does not have on hand. 15 Recently, with the inclusion of technological tools in medical practice, these technologies can be used to assist physicians in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Reproducibility and Equivalence of Cobbmeter Application in the Sagittal Evaluation of the Spine

et al. 2016

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Objective: This study aims to evaluate the reliability and equivalency of using the Cobbmeter application for iPhone compared to the manual measurement method in the analysis of the sagittal spinal alignment. Methods: Cross-sectional, prospective, single-center study that had 20 panoramic radiographs of the spine in lateral view, in a neutral standing position, analyzed blindly and randomly by three independent examiners in three different times. The parameters were pelvic incidence (PI), pelvic tilt (PT) and lumbar lordosis (LL). The statistical analysis was performed to measure the intraclass correlation coefficient (ICC) between the two measurement methods, in addition to measuring the intra and inter-evaluators reliability. Results: For reproducibility analysis, the intra-evaluators ICC using the application resulted in a Kappa (K) of 0.975 for the evaluation of pelvic incidence (PI) evaluation. For pelvic tilt (PT), the K value obtained was 0.981 and the K measured for lumbar lordosis (LL) analysis was 0.987. The inter-evaluators evaluation of reproducibility using the application resulted in a K value of 0.917 for PI, 0.930 for PT and 0.951 for LL. For the assessment of equivalency of methods, comparing the application to the standard method, with a goniometer and dermographic pencil, the K value found for PI was 0.873, for PV was 0.939 and for LL was 0.914. All values were significant (p<0.001) against the null hypothesis. Conclusion: This smartphone application is a valid and reliable instrument for measuring the angle involved in the sagittal balance of the spine. Furthermore, the results show that its applicability is not inferior to the manual method with goniometer and dermographic pencil.Keywords: Spine; Diagnostic imaging; Postural balance; Lordosis; Kyphosis; Pelvis. RESUMO

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Influence of the Sagittal Balance on the Clinical Outcome in Spinal Fusion

Cited by 4 publications

References 29 publications

Clinical Outcomes of Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion in Patients with Lumbar Spinal Stenosis and Degenerative Instability

Clinical Outcomes of Posterolateral Fusion Versus Posterior Lumbar Interbody Fusion in Patients with Lumbar Spinal Stenosis and Degenerative Instability

How Do Pelvic Parameters Correlate With Postoperative Outcomes When the Parameters Are Not Measured Preoperatively in Patients Undergoing Instrumented Lumbar Fusion?

Reproducibility and Equivalence of Cobbmeter Application in the Sagittal Evaluation of the Spine

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