Sagittal Balance Correction in Lateral Interbody Fusion for Degenerative Scoliosis

Blizzard, Daniel J.; Gallizzi, Michael A.; Sheets, Charles; Smith, Benjamin T.; Isaacs, Robert E.; Eure, Megan; Brown, Christopher R.

doi:10.14444/3029

Cited by 12 publications

(4 citation statements)

References 26 publications

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“…Similarly, in their retrospective review of 35 patients who underwent primary lateral interbody fusion, Blizzard et al found a statistically significant increase in global lumbar lordosis, 17 similar to that found in our study. However, their study was again focused on adult spinal deformity patients and did not evaluate for post-operative alignment predictors.…”

Section: Discussionsupporting

confidence: 91%

Supine and Dynamic Extension Radiographs as the Strongest Predictors of Post-operative Alignment in Minimally Invasive Lumbar Spine Surgery

Barber

Lafage

Muzammil

et al. 2022

Global Spine Journal

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Study Design Institutional review board-approved retrospective cohort study. Objectives Failure to achieve alignment goals may result in accelerated adjacent segment degeneration and poorer outcomes. In “open” spine surgery, intraoperative tools can fine tune alignment; minimally invasive spine surgery techniques may not allow for this type of intraoperative adjustment. The aim of this study was to identify pre-operative radiographic parameters that accurately predict post-operative alignment after minimally invasive lumbar spine surgery. We hypothesized that pre-operative supine and extension sagittal alignment would predict post-operative standing alignment. Methods 50 consecutive patients underwent lateral or anterior lumbar interbody fusion with or without percutaneous posterior instrumentation by a single-surgeon. Sagittal alignment parameters were evaluated on pre-operative standing scoliosis radiographs, dynamic radiographs, supine CT scout, and 6-week post-operative standing radiographs. Demographic and perioperative data were analyzed. Results The mean age was 67.8 years. The mean BMI was 29.7. On average, 3 levels were instrumented (range, 2–6). Surgical time was 4.5 ± 1.8 hours. Following surgery, global lordosis increased from 44.7 ± 17° to 48.6 ± 16° ( P = .001). However, there was no significant difference between the pre-operative supine (48.5 ± 15°), pre-operative extension (49.2 ± 18°), or 6-week post-operative standing radiographs (48.6 ± 16°). There were strong correlations between post-operative alignment and pre-operative supine (r = .825) and extension (r = .851) alignment. Conclusions Our results suggest that pre-operative supine and extension radiographs could be a gold standard for minimally invasive lumbar spine surgery alignment correction as they predict post-operative alignment. The extension alignment was the strongest predictor of post-operative alignment.

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Section: Discussionsupporting

confidence: 91%

Supine and Dynamic Extension Radiographs as the Strongest Predictors of Post-operative Alignment in Minimally Invasive Lumbar Spine Surgery

Barber

Lafage

Muzammil

et al. 2022

Global Spine Journal

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“…In recent years, however, other avenues such as minimally invasive TLIF (MIS TLIF), and lateral techniques such as oblique lumbar interbody fusion (OLIF) have gained popularity. The rationale of less-invasive approaches such as MIS TLIF and OLIF is to reduce blood loss and tissue debridement, increasing the tolerability of such surgeries [9,10].…”

Section: Introductionmentioning

confidence: 99%

Sagittal Balance Correction Following Lumbar Interbody Fusion: A Comparison of the Three Approaches

et al. 2019

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Study Design Retrospective cohort study. Purpose The objective of this study was to compare three widely used interbody fusion approaches in regard to their ability to correct sagittal balance, including pelvic parameters. Overview of Literature Restoration of sagittal balance in lumbar spine surgery is associated with better postoperative outcomes. Various interbody fusion techniques can help to correct sagittal balance, with no clear consensus on which technique offers the best correction. Methods The charts and imaging of patients who have undergone surgery through either open transforaminal lumbar interbody fusion (TLIF), minimally invasive TLIF (MIS TLIF), or oblique lumbar interbody fusion (OLIF) were retrospectively reviewed. The following sagittal balance parameters were measured pre- and postoperatively: segmental lordosis, lumbar lordosis, disk height, pelvic tilt, and pelvic incidence. Data on postoperative complications were gathered. Results Only OLIF managed to significantly improve segmental lordosis (4.4°, p <0.001) and lumbar lordosis (4.8°, p =0.049). All approaches significantly augmented disk height, with OLIF having the greatest effect (3.7°, p <0.001). No approaches were shown to significantly correct pelvic tilt. Pelvic incidence remained unchanged in all approaches. Open TLIF was the only approach with a higher rate of postoperative complications (33%, p =0.009). Conclusions The OLIF approach might offer greater correction of sagittal balance over open and MIS TLIF, mainly in regard to segmental lordosis, lumbar lordosis, and disk height. MIS TLIF, although offering more limited access than open TLIF, was not inferior to open TLIF in regard to sagittal balance correction. A higher rate of complications was shown for open TLIF than the other approaches, possibly due to its more invasive nature.

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“…So ist es nicht verwunderlich, dass eine degenerative Veränderung dieser Segmente zu einem deutlichen Verlust der LL führen und damit indirekt einen negativen Einfluss auf die SVA und den kompensatorischen Pelivic Tilt (PT) ausüben kann. Doch muss auch eine postoperativ residuale, positive sagittale Balance mit deskrepantem PI minus LL nicht zwingend mit einem klinisch nachteiligen Outcome einhergehen [13]. Vielmehr ist neben den verfahrenstypischen Risiken (wie z.…”

Section: Klinische Relevanzunclassified

Die Veränderung des sagittalen Profils im Alter und dessen therapeutische Relevanz

Tschöke

2018

Die Wirbelsäule

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ZusammenfassungDie steigende Zahl der komplexen Wirbelsäulendeformitäten im Alter stellt eine neue therapeutische Herausforderung dar. Hierbei wird dem komplexen Zusammenspiel der spinopelvinen Kompensationsmechanismen eine besondere Bedeutung zugeschrieben. Obwohl die Analyse der globalen sagittalen Balance wesentlich zum Verständnis dieser Mechanismen beigetragen hat, wird die vereinfachte algebraische Darstellung und Definition des „normalen“ Sagittalprofils dem älteren Patienten mit multiplen degenerativen Veränderungen des Bewegungsapparates nicht gerecht. Vielmehr ist beim älteren Patienten eine durch die unzureichende Flexibilität der benachbarten Strukturen limitierte „Komfort-Balance“ funktionell nicht zwingend nachteilig. Dennoch sollte das therapeutische Ziel immer die Wiederherstellung einer harmonischen Lastverteilung an der Wirbelsäule sein. Bei älteren Patienten mit einer symptomatisch dekompensierten sagittalen Imbalance, bleibt die rein konservative Therapie meist ohne Erfolg. In diesen Fällen sollte immer die strukturell zugrunde liegende Pathologie im Sinne der Profilkorrektur adressiert werden. Die Wahl der operativen Technik, Länge des Konstrukts und dessen Verankerungspunkte müssen dabei die individuellen Möglichkeiten, Risiken und Bedürfnisse des älteren Patienten berücksichtigen, um eine iatrogene Invalidisierung und komplikationsbedingte Sekundäreingriffe zu vermeiden. Mit stetig steigender Lebenserwartung unserer Bevölkerung werden wir uns dem wachsenden Anspruch, auch im hohen Alter aktiv bleiben zu können, stellen müssen. Dies setzt ein ganzheitliches Verständnis der patienteneigenen Leistungsfähigkeit sowie eine realistische Einschätzung des zu erzielenden Ergebnisses und das Beherrschen aller operativer Korrekturtechniken voraus.

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Sagittal Balance Correction in Lateral Interbody Fusion for Degenerative Scoliosis

Cited by 12 publications

References 26 publications

Supine and Dynamic Extension Radiographs as the Strongest Predictors of Post-operative Alignment in Minimally Invasive Lumbar Spine Surgery

Supine and Dynamic Extension Radiographs as the Strongest Predictors of Post-operative Alignment in Minimally Invasive Lumbar Spine Surgery

Sagittal Balance Correction Following Lumbar Interbody Fusion: A Comparison of the Three Approaches

Die Veränderung des sagittalen Profils im Alter und dessen therapeutische Relevanz

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