Relationship Between Postoperative Lordosis Distribution Index And Adjacent Segment Disease Following L4-S1 Posterior Lumbar Interbody Fusion

Zheng, Guoquan; Wang, Chunguo; Wang, Tianhao; Hu, Wenhao; Ji, Quanbo; Hu, Fanqi; Li, Jianrui; Chaudhary, Surendra Kumar; Song, Kai; Song, Diyu; Zhang, Zhifa; Hao, Yongyu; Wang, Yao; Li, Jing; Zheng, Qingyuan; Wang, Yan

doi:10.21203/rs.2.20711/v1

Cited by 5 publications

(7 citation statements)

References 23 publications

(27 reference statements)

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“…Relevant studies have shown that small LDI in adult spinal deformity may lead to postoperative proximal junctional kyphosis [30]. Zheng et al [10] found that patients with abnormal LDI after PLIF were more likely to have adjacent segment degeneration (ASD) than those with normal LDI, and patients with low LDI were more likely to have ASD than those with high LDI. In this study, the LDI of the 2 cases of internal xation failure was less than 50%, indicating that abnormal LDI will increase the incidence of mechanical complications.…”

Section: Discussionmentioning

confidence: 99%

“…In order to facilitate statistical analysis, according to the literature standard [10,11], we divided the LDI into two groups: the normal group (50% -80%) and the abnormal group (not within 50% -80%), and divided the improvement rate of JOA score into two subgroups: poor (P) group (<50%) and good (G) group (>50%).…”

Section: Data Collection and Clinical Evaluationmentioning

confidence: 99%

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Clinical Significance of PLIF in Restoring L4-S1 Segmental Lordosis of 2-level Isthmic Spondylolisthesis

Wang¹,

Liu²,

Jing³

et al. 2021

Preprint

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Background: Spinal and pelvic sagittal plane balance is closely related to good clinical prognosis, so in the treatment of 2-level isthmic spondylolisthesis, attention should be paid not only to adequate nerve decompression, but also to the correction of lumbosacral sagittal plane parameters. The purpose of this study was to observe the clinical prognosis and sagittal parameters of patients with isthmic spondylolisthesis treated with PLIF, and to find out the risk factors leading to poor prognosis. Methods: From January 2006 to August 2018, the clinical data of patients with 2-level isthmic spondylolisthesis treated with PLIF in the Second Xiangya Hospital of Central South University were retrospectively collected. The clinical symptoms (JOA score and VAS score) and the sagittal parameters of lumbosacral segment (PI, PT, LL, L4-S1 SL, LDI, PI-LL, LL and L4-S1 SL) were recorded before operation, immediately after operation and at the last follow-up. According to the improvement rate of JOA score, the patients were divided into two subgroups, poor(P) group and good(G) group. The parameters within and between the two subgroups were compared. Meanwhile, Pearson correlation analysis was conducted between sagittal parameters and JOA score improvement rate.Results: A total of 52 patients were enrolled in this study, the average age was (59.96 ±9.11) years, and the mean follow-up time was (31.88 ±8.37) months. Group G (n = 37) and group P (n = 15). In terms of clinical symptom improvement and sagittal plane parameters, except PI, the other parameters of the patients were improved compared with those before operation, and the difference was statistically significant. In the intra-group comparison, except PI, other indexes in group G were significantly improved, while in group P, there was no significant difference in PI, LL, L4-S1 SL, LDI, PI-LL before and after operation. In the comparison between groups, there was no significant difference in baseline data between group G and group P; postoperative VAS score(back pain) in group G was lower than that in group P, but there was no significant difference in VAS score( leg pain); in terms of JOA score and JOA score improvement rate, group G was significantly better; △L4-S1 SL ,L4-S1 SL and LDI were larger in group G, and the proportion of patients with normal LDI was higher than that in group P. Pearson correlation analysis showed that postoperative △L4-S1 SL, LDI and L4-S1 SL were positively correlated with JOA improvement rate. 2 patients with failed internal fixation occurred in group P, and the postoperative LDI was less than 50%. Conclusion: PLIF is an effective method for the treatment of 2-level isthmic spondylolisthesis. ΔL4-S1 SL, L4-S1 SL and good LDI may be important sagittal parameters affecting the clinical prognosis of L4 and L5 isthmus spondylolisthesis.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collection and Clinical Evaluationmentioning

confidence: 99%

Clinical Significance of PLIF in Restoring L4-S1 Segmental Lordosis of 2-level Isthmic Spondylolisthesis

Wang¹,

Liu²,

Jing³

et al. 2021

Preprint

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“…The internal xation of the diseased vertebra alone obtains instant stability of the spine. However, the permanent stability of the reconstruction depends on the fusion of the spine [34] . In this study, all diseased intervertebral xation patients underwent bone graft fusion in the diseased vertebra alone and no anterior or posterior normal motor unit fusions were allowed to occur, which is in stark contrast to the non-diseased intervertebral approach, which relies heavily on the degree of spinal fusion to determine the effectiveness of non-diseased intervertebral xation.Bone grafting support is another essential component of the diseased intervertebral surgery.…”

Section: Discussionmentioning

confidence: 99%

Selection of the Fusion and Fixation Range in the Intervertebral Surgery to Correct Thoracolumbar and Lumbar Tuberculosis：A Retrospective Clinical Study

Yang

Liu

Niu

et al. 2021

Preprint

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Background To compare the diseased verses the non-diseased intervertebral surgery used in the treatment of thoracolumbar and lumbar spinal tuberculosis and to explore the best choice of fusion of fixation range.Methods 221 patients with thoracolumbar and lumbar tuberculosis were categorized into two groups. 118 patients underwent the diseased intervertebral surgery (lesion vertebral pedicle fixation, Group A) and 103 patients underwent the non-diseased intervertebral surgery (1 or 2 vertebral fixation above and below the affected vertebra, group B). Spinal tuberculosis diagnosis was confirmed in both groups of patients before lesion removal, bone graft fusion, and internal fixation. Clinical data and efficacy of the two surgical methods were then evaluated. Results The mean follow-up duration for both procedures was 65 months (50-68 months range). There were no significant differences in laboratory examinations,VAS scores, and the Cobb angle correction rate and the angle loss. However, significant differences existed in the operation time, blood loss, serosanguineous drainage volume, and blood transfusion requirement between the two groups. The diseased intervertebral surgery group performed significantly better than the non-diseased intervertebral surgery group in all of these areas. In both cases, the bone graft fused completely with the normal bone by the last follow-up, occuring at 50-86 months post surgery.Conclusion The diseased intervertebral surgery is a safe and feasible option for the treatment of thoracolumbar and lumbar tuberculosis. It effectively restores the physiological curvature of the spine and reduces the degeneration of adjacent vertebral bodies in the spinal column.

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“…In a recent study of patients undergoing lumbar interbody fusion, the authors found that maldistributed lordosis was associated to postoperative adjacent segment disease (ASD). 18 To our knowledge, the LDI has not been assessed in patients undergoing instrumented spine surgery which we sought to assess.…”

Section: Neurospine Eissn 2586-6591 Pissn 2586-6583mentioning

confidence: 99%

“…Recently, Zheng et al 18 assessed the LDI in 215 consecutive patients undergoing posterior lumbar interbody fusion. They found that LDI maldistribution was associated to postoperative ASD.…”

Section: Lordosis Distribution Indexmentioning

confidence: 99%

Lordosis Distribution Index in Short-Segment Lumbar Spine Fusion – Can Ideal Lordosis Reduce Revision Surgery and Iatrogenic Deformity?

et al. 2021

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Objective: The demand for spinal fusion is increasing, with concurrent reports of iatrogenic adult spinal deformity (flatback deformity) possibly due to inappropriate lordosis distribution. This distribution is assessed using the lordosis distribution index (LDI) which describes the upper and lower arc lordosis ratio. Maldistributed LDI has been associated to adjacent segment disease following interbody fusion, although correlation to later-stage deformity is yet to be assessed. We therefore aimed to investigate if hypolordotic lordosis maldistribution was associated to radiographic deformity-surrogates or revision surgery following instrumented lumbar fusion.Methods: All patients undergoing fusion surgery ( ≤ 4 vertebra) for degenerative lumbar diseases were retrospectively included at a single center. Patients were categorized according to their postoperative LDI as: “normal” (LDI 50–80), “hypolordotic” (LDI < 50), or “hyperlordotic” (LDI > 80).Results: We included 149 patients who were followed for 21 ± 14 months. Most attained a normally distributed lordosis (62%). The hypolordotic group had increased postoperative pelvic tilt (PT) (p < 0.001), pelvic incidence minus lumbar lordosis (PI–LL) mismatch (p < 0.001) and decreased global lordosis (p = 0.007) compared to the normal group. Survival analyses revealed a significant difference in revision surgery (p = 0.03), and subsequent multivariable logistic regression showed increased odds of 1-year revision in the hypolordotic group (p = 0.04). There was also a negative, linear correlation between preoperative pelvic incidence (PI) and postoperative LDI (p < 0.001).Conclusion: In patients undergoing instrumented lumbar fusion surgery, hypolordotic lordosis maldistribution (LDI < 50) was associated to increased risk of revision surgery, increased postoperative PT and PI–LL mismatch. Lordosis distribution should be considered prior to spinal fusion, especially in high PI patients.

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Relationship Between Postoperative Lordosis Distribution Index And Adjacent Segment Disease Following L4-S1 Posterior Lumbar Interbody Fusion

Cited by 5 publications

References 23 publications

Clinical Significance of PLIF in Restoring L4-S1 Segmental Lordosis of 2-level Isthmic Spondylolisthesis

Clinical Significance of PLIF in Restoring L4-S1 Segmental Lordosis of 2-level Isthmic Spondylolisthesis

Selection of the Fusion and Fixation Range in the Intervertebral Surgery to Correct Thoracolumbar and Lumbar Tuberculosis：A Retrospective Clinical Study

Lordosis Distribution Index in Short-Segment Lumbar Spine Fusion – Can Ideal Lordosis Reduce Revision Surgery and Iatrogenic Deformity?

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