The Influence of Lordotic cages on creating Sagittal Balance in the CMIS treatment of Adult Spinal Deformity

Anand, Neel; Cohen, Ryan; Cohen, Jason; Kahndehroo, Babak; Kahwaty, Sheila; Baron, Eli M.

doi:10.14444/4023

Cited by 31 publications

(17 citation statements)

References 60 publications

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“…Other authors found correction capability of the hyperlordotic cages through the anterior and lateral approach highly efficient. [8][9][10] Although not much could be found in the literature, the complication rate is seemingly low and not significantly dissimilar to ours. 11,12 In our experience, we had fewer postoperative neurological dysfunctions after using the hyperlordotic XLIF cages as compared with regular XLIF cages.…”

Section: Discussioncontrasting

confidence: 63%

Lumbar Lordosis Correction With Interbody Hyperlordotic Cages: Initial Experience, Learning Curve, Technical Aspects, and Complication Incidence

2018

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Background: Analysis of the initial experience on learning curve, technical differences and perioperative or early postoperative complications using lumbar hyperlordotic anterior and lateral interbody cages for the correction of lumbar lordosis as compared with the usage of regular lordotic cages. Methods: Initial 21 consecutive patients were treated with 13 hyperlordotic anterior lumbar interbody fusion (ALIF) cages and 8 hyperlordotic extreme lateral interbody fusion (XLIF) cages. The mean patient age was 64 years, and the mean lumbar hypolordosis was 238. Results: No significant procedure-related technical differences were found between the hyperlordotic and nonhyperlordotic ALIF cages. Slightly significant procedure-related technical differences were found between hyperlordotic and nonhyperlordotic XLIF cages. The complication type and occurrence were comparable. Conclusions: Sagittal balance correction of lumbar lordosis using hyperlordotic ALIF and XLIF cages is a relatively safe surgical procedure with a short learning curve for those surgeons already familiar with anterior and lateral retroperitoneal procedures.

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Section: Discussioncontrasting

confidence: 63%

Lumbar Lordosis Correction With Interbody Hyperlordotic Cages: Initial Experience, Learning Curve, Technical Aspects, and Complication Incidence

2018

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“…In previous studies, LIF was shown to have improved segmental sagittal alignment [21], with an increase in disk height of 41.9%-83% and an increase in foraminal height of 13.5%-83% [22,23]. Anand et al [23] reported an 8.1° increase in segmental lordosis in ASD cases treated with LIF using a 10° cage. In an investigation of 80 patients (mean fusion level, 1.5 levels), Shiga et al [24] found that the acquired lordotic angle was 3.8° after LIF with 6° lordotic cages.…”

Section: Discussionmentioning

confidence: 93%

“…This cage is useful for the correction of ASD to restore disk height in cases where degeneration is the main cause of the deformity [3]. In previous studies, LIF was shown to have improved segmental sagittal alignment [21], with an increase in disk height of 41.9%-83% and an increase in foraminal height of 13.5%-83% [22,23]. Anand et al [23] reported an 8.1° increase in segmental lordosis in ASD cases treated with LIF using a 10° cage.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Postoperative Sagittal Alignment after Lateral Lumbar Interbody Fusion in Adult Spinal Deformity: Posterior Osteotomy, Anterior Longitudinal Ligament Rupture, and Endplate Injury

et al. 2019

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To identify factors that affect sagittal alignment correction in lateral lumbar interbody fusion (LIF) surgery for adult spinal deformity (ASD) and to investigate the degree of correction in each condition. Overview of Literature: LIF is a useful procedure for ASD, but the degree of correction can be affected by posterior osteotomy, intraoperative endplate injury, or anterior longitudinal ligament (ALL) rupture. Methods: Radiographical data for 30 patients who underwent LIF for ASD were examined prospectively. All underwent two-stage surgery (LIF followed by posterior fixation). Radiographical parameters were measured preoperatively, after LIF, and after posterior fixation; these included the segmental lordotic angle, lumbar lordosis (LL), and other sagittal alignment factors. Results: LL was corrected from 16.5°±16.7° preoperatively to 33.4°±13.8° after LIF (p<0.001) and then to 52.1°±7.9° following posterior fixation (p<0.001). At levels where Schwab grade 2 osteotomy was performed, the acquired segmental lordotic angles from the preoperative value to after posterior fixation and from after LIF to after posterior fixation were 19.5°±9.2° and 9.9°±3.9°, respectively. On average, 12.4° more was added than in cases without osteotomy. Endplate injury was identified at 21 levels (19.4%) after LIF, with a mean loss of 3.4° in the acquired segmental lordotic angle (5.3°±8.4° and 1.9°±5.9° without and with endplate injury, respectively). ALL rupture was identified at seven levels (6.5%), and on average 19.3° more was added in these cases between the preoperative and postoperative values than in cases without ALL rupture. Conclusions: LIF provides adequate sagittal alignment restoration for ASD, but the degree of correction is affected by grade 2 osteotomy, intraoperative endplate injury, and ALL rupture.

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“…In previous studies, LLIF resulted in improved local sagittal alignment [18]. In addition, an increase in disc height from 41.9% to 83% and an increase in foraminal height from 13.5% to 83% were observed after LLIF [19,20]. As for the segmental acquired lordotic angle achieved with LLIF, Anand et al [20] reported an 8.1° increase in segmental lordosis in adult spinal deformity cases with LLIF, using a 10° cage.…”

Section: Discussionmentioning

confidence: 95%

Comparative Radiographic Outcomes of Lateral and Posterior Lumbar Interbody Fusion in the Treatment of Degenerative Lumbar Kyphosis

et al. 2019

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Study Design Retrospective case–control study. Purpose To compare surgical invasiveness and radiological outcomes between posterior lumbar interbody fusion (PLIF) and lateral lumbar interbody fusion (LLIF) for degenerative lumbar kyphosis. Overview of Literature LLIF is a minimally invasive interbody fusion technique; however, few reports compared the clinical outcomes of conventional PLIF and LLIF for degenerative lumbar kyphosis. Methods Radiographic data for patients who have undergone lumbar interbody fusion (≥3 levels) using PLIF or LLIF for degenerative lumbar kyphosis (lumbar lordosis [LL] <20°) were retrospectively examined. The following radiographic parameters were retrospectively evaluated preoperatively and 2 years postoperatively: segmental lordotic angle, LL, pelvic tilt (PT), pelvic incidence (PI), C7 sagittal vertical axis, and T1 pelvic angle. Results Nineteen consecutive cases with PLIF and 27 cases with LLIF were included. There were no significant differences in patients’ backgrounds or preoperative radiographic parameters between the PLIF and the LLIF groups. The mean fusion level was 5.5±2.5 levels and 5.8±2.5 levels in the PLIF and LLIF groups, respectively ( p =0.69). Although there was no significant difference in surgical times ( p =0.58), the estimated blood loss was significantly greater in the PLIF group ( p <0.001). Two years postoperatively, comparing the PLIF and LLIF groups, the segmental lordotic angle achieved (7.4°±7.6° and 10.6°±9.4°, respectively; p =0.03), LL (27.8°±13.9° and 39.2°±12.7°, respectively; p =0.006), PI–LL (19.8°±14.8° and 3.1°±17.5°, respectively; p =0.002), and PT (22.6°±7.1° and 14.2°±13.9°, respectively; p =0.02) were significantly better in the LLIF group. Conclusions LLIF provided significantly better sagittal alignment restoration in the context of degenerative lumbar kyphosis, with less blood loss.

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The Influence of Lordotic cages on creating Sagittal Balance in the CMIS treatment of Adult Spinal Deformity

Abstract: Background

Cited by 31 publications

References 60 publications

Lumbar Lordosis Correction With Interbody Hyperlordotic Cages: Initial Experience, Learning Curve, Technical Aspects, and Complication Incidence

Lumbar Lordosis Correction With Interbody Hyperlordotic Cages: Initial Experience, Learning Curve, Technical Aspects, and Complication Incidence

Factors Affecting Postoperative Sagittal Alignment after Lateral Lumbar Interbody Fusion in Adult Spinal Deformity: Posterior Osteotomy, Anterior Longitudinal Ligament Rupture, and Endplate Injury

Comparative Radiographic Outcomes of Lateral and Posterior Lumbar Interbody Fusion in the Treatment of Degenerative Lumbar Kyphosis

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