Lumbar alignment and patient-reported outcomes after single-level transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with and without local coronal imbalance

Abstract

OBJECTIVEThe purpose of this study was to compare the preoperative radiographic features of degenerative lumbar spondylolisthesis (DLS) with and without local coronal imbalance (LCI) and to investigate the surgical outcomes of transforaminal lumbar interbody fusion (TLIF) in the treatment of DLS with LCI at the spondylolisthesis level. DLS with scoliotic disc wedging and/or lateral listhesis at the same involved segment, as well as LCI, constitutes a distinct subgroup. However, previous studies concerning surgical outcomes focused mainly on sagittal profiles. There is a paucity of valid data regarding lumbar coronal alignment and patient-reported outcomes (PROs) after surgery in DLS with LCI.METHODSThe authors reviewed consecutive patients who received TLIF for L4/5 DLS between 2009 and 2018. Patients were assigned to the LCI and non-LCI groups based on preoperative radiographs. Demographics, radiographic parameters related to both sagittal and coronal alignment, and PROs were compared between the 2 groups.RESULTSThere were 21 patients in the LCI and 80 in the non-LCI group. Compared with the non-LCI group, the LCI group was characterized by lower preoperative lumbar lordosis on sagittal alignment (38.3° vs 43.7°, p < 0.05), higher lumbar Cobb angle on coronal alignment (12.4° vs 5.1°, p < 0.05), and worse lumbar coronal balance (18.5 mm vs 6.8 mm, p < 0.05). After surgery, lumbar alignment in the sagittal and coronal planes was significantly improved in the LCI group, whereas no significant changes occurred in the non-LCI group. Scores on the preoperative Oswestry Disability Index and the visual analog scale for back pain and leg pain scores were significantly higher in the LCI group, whereas no differences were found between the 2 groups in the postoperative evaluation (p > 0.05).CONCLUSIONSDLS with LCI constitutes a distinct subgroup characterized by coronal malalignment and loss of whole lumbar lordosis, which may result in worse PROs. The TLIF procedure allows the reconstruction of the coronal and sagittal lumbar profile and achievement of satisfactory PROs.

Reduction Capacity and Factors Affecting Slip Reduction Using Cortical Bone Trajectory Technique in Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis

“…Because instrumentation failure is the result of a complex combination of factors, the reduction maneuver itself may go unrecognized as a possible cause. This study showed a comparable or superior slip reduction rate to those reported in previous studies 3,[18][19][20][21][22][23][24] . (Table 3) One reason for the favorable results may be that the preoperative vertebral slip, which was identified as a factor contributing to the slip reduction rate in this study, was not as large as in other Spine Surgery and Related Research J-STAGE Advance Publication (February 10, 2022) Ⓒ The Japanese Society for Spine Surgery and Related Research.…”

Evaluation of the Predictors for Unfavorable Clinical Outcomes of Degenerative Lumbar Spondylolisthesis After Lumbar Interbody Fusion Using Machine Learning

“…In other words, the difference between the two groups postoperatively was not statistically significant (1.93 vs. 2.24, p = 0.172), and measurement of preoperative coronal imbalance was more valuable. The role of sagittal lumbar alignment in assessing disease grade and deciding on individualized surgical strategies was well recognized in published articles ( 1 – 3 , 7 ), but coronal malalignment was an equally important issue to be treated with caution ( 1 , 36 , 37 ). Although we identified the presence of LLS preoperatively and targeted the restoration of normal lumbar coronal balance by obtaining greater lumbar lordosis intraoperatively ( 38 ), the consideration was reflected in the comparison of postoperative data, but an inferior PRO was still observed.…”

“…There were several conceivable reasons for the poor outcomes. First, asymmetric degenerative changes lead to disc collapse and laxity of the paravertebral ligaments, manifested by LLS of vertebral body and lateral displacement of the disc ( 1 ). This complicated deformity had more severe pathological changes than a mere sagittal imbalance.…”

“…A limited surgical benefit was observed in DLS with LLS, including an elevated and persistent back pain due to the coronal displacement of the slipped segment ( 36 ). Second, purposeful surgical strategies and instruments were recommended to correct vertebral slippage in patients with lateral slippage, including preserving the lumbar lordosis, implanting a larger cage and laterally distracting the displaced vertebral body ( 1 , 39 ). However, higher restoration requirements were frequently associated with increased risk of major complications, including extensive soft tissue injury and intraoperative blood loss, all of which can reduce short-term PROs ( 9 ).…”

“…As the aging society comes, degenerative lumbar spondylolisthesis (DLS) with symptomatic stenosis presents a serious challenge to healthcare (1,2). After struggling with the dilemma of decompress treatment, spine surgeons have recognized that it will cause inferior postoperative outcomes without fusion, including persistent pain, pseudarthrosis, and progressive degenerative changes (3)(4)(5).…”