Does method matter? a comparative radiographic evaluation of spinopelvic parameters in single degree lumbar fusion.
Backbone J. 2018 Apr 06;:
Authors: Ahlquist S, Park HY, Gatto J, Shamie AN, Park DY
BACKGROUND CONTEXT: Lumbar fusion is a well-liked and efficient surgical choice to supply stability and restore anatomy. Explicit consideration has lately been targeted on sagittal alignment and radiographic spinopelvic parameters that apply to lumbar fusion in addition to spinal deformity instances. Present literature has demonstrated the effectiveness of varied strategies of lumbar fusion, nevertheless comparative information of those strategies is proscribed.
PURPOSE: To instantly evaluate the influence of varied lumbar fusion strategies (ALIF, LLIF, TLIF, PLF) primarily based on radiographic parameters.
STUDY DESIGN/SETTING: A single-center retrospective examine analyzing pre-operative and post-operative radiographs.
PATIENT SAMPLE: A consecutive record of lumbar fusion surgical procedures carried out by a number of backbone surgeons at a single establishment from 2013-2016 have been recognized.
OUTCOME MEASURES: Radiographic measurements utilized included segmental lordosis (SL), lumbar lordosis (LL), pelvic incidence (PI), pelvic incidence-lumbar lordosis mismatch (PI-LL), anterior and posterior disk peak (DH-A, DH-P respectively), and foraminal peak (FH).
METHODS: Radiographic measurements have been carried out on pre-operative and post-operative lateral lumbar radiographs on all single-level lumbar fusion instances. Demographic information was collected together with age, gender, method, prognosis, surgical degree, and implant lordosis. Paired pattern t-test, one-way ANOVA, McNemar Take a look at, and impartial pattern t-test have been used to determine important variations within the final result measures. A number of linear regression was carried out to find out a predictive mannequin for lordosis from implant lordosis, fusion method, and surgical degree.
RESULTS: There have been 164 sufferers (78 males, 86 females) with a imply age of 60.1 years and common radiographic observe up time of 9.three months. These included 34 ALIF, 23 LLIF, 63 TLIF, and 44 PLF surgical procedures. ALIF and LLIF considerably improved SL (7.9° & four.four°), LL (5.5° & 7.7°), DH-A (eight.eight mm & 5.eight mm), DH-P (three.four mm & 2.three mm), and FH (2.eight mm & 2.5 mm), respectively (p ? .003). TLIF considerably improved these parameters, albeit to a lesser extent: SL (1.7°), LL (2.7°), DH-A (1.1 mm), DH-P (zero.eight mm), and FH (1.1 mm), p ? .02. PLF didn’t considerably alter any of those parameters whereas considerably decreasing FH (-1.three mm, p = .01). One-way ANOVA confirmed no important variations between ALIF and LLIF aside from ALIF with higher ?DH-A (three.zero mm, p = .02). Each ALIF and LLIF considerably outperformed PLF in pre-operative to post-operative change in all parameters p ? .001. Moreover, ALIF considerably outperformed TLIF within the change in SL (6.2°, p < .001) and LLIF considerably outperformed TLIF within the change in LL (5.zero°, p = .02). Each outperformed TLIF in ?DH-A (7.7 mm & four.7 mm) and ?DH-P (2.6 mm & 1.5 mm), respectively (p ? .02). ALIF was the one fusion method that considerably improved the proportion of sufferers with a PI-LL < 10° (zero.41 to zero.66, p = .02). Lordotic cages had superior enchancment of all parameters as in comparison with non-lordotic cages (p <.001). Implant lordosis (m = 1.1), fusion method (m = 6.eight), and surgical degree (m = 6.9) considerably predicted post-operative SL (p < .001, R2 = .56).
CONCLUSIONS: This examine demonstrated that these 4 lumbar fusion strategies yield divergent radiographic outcomes. ALIF and LLIF produced higher enhancements in radiographic measurements post-operatively as in comparison with TLIF and PLF. ALIF was probably the most profitable in bettering PI-LL mismatch, an vital parameter regarding sagittal alignment. Lordotic implants offered higher sagittal correction and surgeons must be cognizant of the influence that these differing implants and strategies produce after surgical procedure. Surgical method is a vital determinant of post-operative alignment and has ramifications upon sagittal alignment in lumbar fusion surgical procedure.
PMID: 29631061 [PubMed – as supplied by publisher]