Lumbar Sagittal Balance Influences the Clinical Outcome After Decompression and Posterolateral Spinal Fusion for Degenerative Lumbar Spondylolisthesis

Kawakami, Mamoru; Tamaki, Toru; Ando, Muneharu; Yamada, Hiroshi; Hashizume, Hiroshi; Yoshida, Munehito

doi:10.1097/00007632-200201010-00014

Cited by 159 publications

(98 citation statements)

References 9 publications

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“…There is no attempt to relate lordosis gain to improved patient-related outcomes, yet this relationship is established in the literature [5,7,10,19]. Long-term follow-up would be required to confirm reduced adjacent segment degeneration with improved monosegmental lordosis.…”

Section: Discussionmentioning

confidence: 99%

“…The initial rod placement with distraction allowed the final disc space preparation, distraction, and insertion of the paired lordotic PEEK cages/spacers looking to achieve the maximum height. Insertion of the cages used an 'insert and rotate' (90°) maneuver to obtain optimum cage position [7,10,11,19]. Two types of PEEK cages (spacers) were used: the R90/Hourglass (Medtronic, Minneapolis, MN, USA) and the CoRoent (NuVasive, San Diego, CA, USA).…”

Section: Surgical Techniquementioning

confidence: 99%

“…The importance of normal sagittal alignment has been increasingly recognised in multi-segmental fusions for spinal deformity [1][2][3]. With increasing focus on patient-related outcomes, there is mounting evidence that optimum sagittal alignment in lumbar fusion is associated with improved outcomes across differing pathologies [1,[4][5][6][7][8][9], reduced post-surgical pain [1-3, 5-8, 10-13], reduced adjacent segment degeneration [4,5,7,[9][10][11][12][13][14], and reduced revision rates [1-5, 7, 9-11, 13, 15-18].…”

Section: Introductionmentioning

confidence: 99%

“…Pathological processes that result in disc space narrowing will reduce lordosis. Failure to correct this pre-operative sagittal plane deformity will compromise results in both the short and long terms [5,7,10,11,13].…”

Section: Introductionmentioning

confidence: 99%

“…It is interesting, however, that with interbody reconstruction, the degree of lordosis recreation can be limited and may not recreate normality [1][2][3][16][17][18]]-a concern when we recognise the significant lordosis in the normal L4/5 and L5/S1 discs [1,5,7,12].…”

Section: Introductionmentioning

confidence: 99%

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Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

2017

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Purpose To examine monosegmental lordosis after posterior lumbar interbody fusion (PLIF) surgery and relate lordosis to cage size, shape, and placement. Methods Eighty-three consecutive patients underwent single-level PLIF with paired identical lordotic cages involving a wide decompression and bilateral facetectomies. Cage parameters relating to size (height, lordosis, and length) and placement (expressed as a ratio relative to the length of the inferior vertebral endplate) were recorded. Centre point ratio (CPR) was the distance to the centre of both cages and indicated mean position of both cages. Posterior gap ratio (PGR) was the distance to the most posterior cage and indicated position and cage length indirectly. Relationships between lordosis and cage parameters were explored. Results Mean lordosis increased by 5.98°(SD 6.86°). The cages used varied in length from 20 to 27 mm, in lordosis from 10°to 18°, and in anterior cage height from 10 to 17 mm. The mean cage placement as determined by CPR was 0.54 and by PGR was 0.16. The significant correlations were: both CPR and PGR with lordosis gain at surgery (r = 0.597 and 0.537, respectively, p \ 0.001 both), cage lordosis with the final lordosis (r = 0.234, p \ 0.05), and anterior cage height was negatively correlated with a change in lordosis (r = -0.297, p \ 0.01).Conclusion Cage size, shape, and position, in addition to surgical technique, determine lordosis during PLIF surgery. Anterior placement with sufficient ''clear space'' behind the cages is recommended. In addition, cages should be of moderate height and length, so that they act as an effective pivot for lordosis.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

2017

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Fusion angle affects intervertebral adjacent spinal segment joint forces—Model‐based analysis of patient specific alignment

Senteler

Weisse

Rothenfluh

et al. 2016

Journal Orthopaedic Research

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This study addresses the hypothesis that adjacent segment intervertebral joint loads are sensitive to the degree of lordosis that is surgically imposed during vertebral fusion. Adjacent segment degeneration is often observed after lumbar fusion, but a causative mechanism is not yet clearly evident. Altered kinematics of the adjacent segments and potentially nonphysiological mechanical joint loads have been implicated in this process. However, little is known of how altered alignment and kinematics influence loading of the adjacent intervertebral joints under consideration of active muscle forces. This study investigated these effects by simulating L4/5 fusions using kinematics-driven musculoskeletal models of one generic and eight sagittal alignment-specific models. Models featured different spinopelvic configurations but were normalized by body height, masses, and muscle properties. Fusion of the L4/5 segment was implemented in an in situ (22˚), hyperlordotic (32˚), and hypolordotic (8˚) fashion and kinematic input parameters were changed accordingly based on findings of an in vitro investigation. Bending motion from upright standing to 45˚forward flexion and back was simulated for all models in intact and fused conditions. Joint loads at adjacent levels and moment arms of spinal muscles experienced changes after all types of fusion. Hypolordotic configuration led to an increase of adjacent segment (L3/4) shear forces of 29% on average, whereas hyperlordotic fusion reduced shear by 39%. Overall, L4/5 in situ fusion resulted in intervertebral joint forces closest to intact loading conditions. An artificial decrease in lumbar lordosis (minus 14˚on average) caused by an L4/5 fusion lead to adverse loading conditions, particularly at the cranial adjacent levels, and altered muscle moment arms, in particular for muscles in the vicinity of the fusion. ß

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Lateral Access Minimally Invasive Spine Surgery

Wang¹,

Sama²,

Uribe³

2017

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part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made.

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Lumbar Sagittal Balance Influences the Clinical Outcome After Decompression and Posterolateral Spinal Fusion for Degenerative Lumbar Spondylolisthesis

Abstract: Both preoperative L1 axis S1 distance and lordosis at follow-up assessment affected surgical outcome. Reduction of slippage may improve clinical outcomes of posterolateral fusion for degenerative lumbar spondylolisthesis with an L1 axis S1 distance more than 35 mm.

Cited by 159 publications

References 9 publications

Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

Fusion angle affects intervertebral adjacent spinal segment joint forces—Model‐based analysis of patient specific alignment

Lateral Access Minimally Invasive Spine Surgery

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