Pelvic Incidence–Lumbar Lordosis Mismatch Is Predisposed to Adjacent Segment Degeneration After Single-Level Anterior Lumbar Interbody Fusion: A Retrospective Case-Control Study

Abstract

Objective: Spinopelvic parameters play important roles in clinical outcomes and disability after short-segment fusion surgery for degenerative spine disease. This study aimed to investigate the relationship between preoperative or postoperative spinopelvic parameters and symptomatic adjacent segment degeneration (ASD) after single-level anterior lumbar interbody fusion (ALIF) surgery at the L4–5 segments.Methods: All patients who underwent single-level ALIF at the L4–5 level from January 2010 to December 2013 and were followed up for 5 years were analyzed. We collected the degree of degeneration at adjacent segments and preoperative and postoperative spinopelvic parameters. We compared the preoperative and postoperative parameters between patients with and without symptomatic ASD.Results: Sixty-one patients were included in our study, and 30 patients had symptomatic ASD. Degeneration at adjacent segments and preoperative spinopelvic parameters did not affect the occurrence of symptomatic ASD. Patients with symptomatic ASD had higher postoperative pelvic tilt (PT) and a mismatch between lumbar lordosis (LL) and pelvic incidence (PI) compared to those without. Postoperative PT > 15° and PI–LL mismatch > 10° were significant risk factors for symptomatic ASD.Conclusion: High PT and PI–LL mismatch were significant risk factors for symptomatic ASD after single-level ALIF surgery. Spine surgeons should consider achieving proper LL to insert the cage at the appropriate angle and prevent a PI–LL mismatch value > 10° after single-level fusion surgery.

Re-Evaluating the Long-Term Efficacy of Semi-Rigid Fixation Using a Nitinol Spring Rod in Lumbar Surgery: A Retrospective Study on an Effective Alternative for Reducing Adjacent Segment Disease

“…Lumbar surgery, primarily dominated by rigid fusion techniques, has been a cornerstone in treating degenerative spinal conditions [1]. However, this approach has been increasingly scrutinized due to the rising incidence of adjacent segment disease (ASD), a significant complication that compromises patients' long-term outcomes [2][3][4][5][6][7][8][9][10]. In spine surgery, ASD is defined as degeneration occurring in the mobile segments above or below the fused spinal segment, and it can result in adjacent segment listhesis, instability, herniated nucleus pulposus, stenosis, hypertrophic facet arthritis, scoliosis, and vertebral compression fractures [11,12].…”

Relationships Between Skeletal Muscle Mass, Lumbar Lordosis, and Chronic Low Back Pain in the Elderly

“…While it is hard to pinpoint a specific cause of low back pain, approximately 97% of low back pain is believed to be related to mechanical causes [ 2 ]. This has given rise to a growing body of research focusing on recovery or rehabilitation after surgical interventions for these causes [ 3 , 4 ], prognostic predictions for postoperative outcomes [ 5 ], and parameters associated with CLBP [ 6 - 9 ]. To prevent or treat CLBP, maintaining sound mechanical integrity of low back would be crucial because stability of spine depends on passive spinal column, active spinal muscles, and neural controls [ 10 ].…”

“…The importance of healthy muscular control on spinal column was evidenced that muscular activation or training helped to prevent CLBP by providing stability or postural correction [ 10 ]. Also, altered sagittal alignment has been described as a substantially influencing factor for CLBP including symptomatic adjacent segment degeneration [ 5 ], and a meaningful relationship has been reported between CLBP and decreased lumbar lordotic angles (LLAs) [ 8 , 16 - 18 ]. Considering muscle integrity is important for maintaining normal LLA [ 19 , 20 ] and adequate sagittal balance [ 21 ], there may be a significant association between loss of skeletal muscle mass and CLBP, probably through altered sagittal balance such as changes of LLA.…”