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Effectiveness of intraoperative table modification for achieving lumbar lordosis in multilevel lumbar fusion surgery: a propensity score-matched study – Lumbar Fusion

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This article explores the use of intraoperative table modification (TM) to improve restoration of lumbar lordosis (LL) in multilevel posterior lumbar interbody fusion (PLIF) with posterior screw fixation. The study retrospectively reviewed the medical records of patients who underwent three- or four-level PLIF and compared those who received TM-PLIF to those who did not. The results showed that TM-PLIF led to better correction of lordosis compared to non-TM-PLIF. The visual analogue scale (VAS) scores for back and leg pain were not significantly different between the two groups. Furthermore, the efficacy of lordosis correction in the TM-PLIF group showed a negative correlation between bone mineral density (BMD) and sacral slope (SS) change both before and after surgery. The authors conclude that TM-PLIF shows potential advantages for restoring and maintaining LL in multilevel lumbar fusion, especially in cases with low BMD. Further study is needed to establish its efficacy conclusively

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSION: Whilst further study is required to conclusively establish its efficacy, TM-PLIF (table modification using gravitational dropping) shows potential advantages for restoring and maintaining LL in multilevel lumbar fusion, particularly in cases with low BMD.

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Br J Neurosurg. 2023 Jul 16:1-9. doi: 10.1080/02688697.2023.2233640. Online ahead of print.ABSTRACTBACKGROUND: In multilevel posterior lumbar interbody fusion (PLIF) with posterior screw fixation, obtaining sufficient lumbar lordosis (LL) is difficult, especially in patients with osteoporosis. We performed intraoperative table modification (TM) using gravitational dropping of the patient’s lumbar spine, to improve restoration of LL.METHODS: We,

Br J Neurosurg. 2023 Jul 16:1-9. doi: 10.1080/02688697.2023.2233640. Online ahead of print.

ABSTRACT

BACKGROUND: In multilevel posterior lumbar interbody fusion (PLIF) with posterior screw fixation, obtaining sufficient lumbar lordosis (LL) is difficult, especially in patients with osteoporosis. We performed intraoperative table modification (TM) using gravitational dropping of the patient’s lumbar spine, to improve restoration of LL.

METHODS: We retrospectively reviewed the medical records of patients who underwent three- or four-level PLIF between 2005 and 2019. One hundred eleven patients were enrolled, with 96 patients receiving non-TM-PLIF and 15 patients receiving TM-PLIF. Radiological parameters, including segmental lordosis (SL), LL, sacral slope (SS), pelvic incidence, and pelvic tilt, were measured. Clinical outcomes were measured using a visual analogue scale (VAS) for the back and leg preoperatively and at the last follow-up. Additionally, the correlation between the bone mineral density (BMD) and the radiological parameters was calculated for TM-PLIF. We performed propensity score matching between the groups to control the baseline difference.

RESULTS: We found a statistically better correction between immediate and last follow-up postoperative SL (p = 0.04), as well as between preoperative and last follow-up SL (p < 0.01) in the TM-PLIF group compared to that in the non-TM-PLIF group. VAS for the back and leg were not significantly different between the two groups. Additionally, the efficacy of lordosis correction in the TM-PLIF group showed a statistically significant negative correlation between BMD and the SS change both before and after the surgery (rho = -0.60, p = 0.02).

CONCLUSION: Whilst further study is required to conclusively establish its efficacy, TM-PLIF (table modification using gravitational dropping) shows potential advantages for restoring and maintaining LL in multilevel lumbar fusion, particularly in cases with low BMD.

PMID:37455353 | DOI:10.1080/02688697.2023.2233640

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Effectiveness of intraoperative table modification for achieving lumbar lordosis in multilevel lumbar fusion surgery: a propensity score-matched study

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Br J Neurosurg. 2023 Jul 16:1-9. doi: 10.1080/02688697.2023.2233640. Online ahead of print.ABSTRACTBACKGROUND: In multilevel posterior lumbar interbody fusion (PLIF) with posterior screw fixation, obtaining sufficient lumbar lordosis (LL) is difficult, especially in patients with osteoporosis. We performed intraoperative table modification (TM) using gravitational dropping of the patient's lumbar spine, to improve restoration of LL.METHODS: We

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