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Exploring the Impact of Mild-to-Moderate Foraminal Stenosis at L5-S1 on Clinical Outcomes Following L4-5 Posterior Lumbar Interbody Fusion – Lumbar Fusion

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The article discusses the clinical and radiographic outcomes of patients undergoing L4-5 posterior lumbar interbody fusion (PLIF) surgery with and without mild-to-moderate L5-S1 foraminal stenosis (FS). The study found that patients with L5-S1 FS had more severe central stenosis, as well as smaller preoperative disc height, larger sagittal vertical axis, smaller lumbar lordosis, and larger pelvic incidence-lumbar lordosis mismatch. Additionally, the patients with L5-S1 FS had poorer clinical outcomes, experiencing more back pain and higher scores on the Oswestry Disability Index (ODI) after the surgery. The study suggests that patients with L5-S1 FS should be carefully examined before undergoing L4-5 fusion due to the potential adverse outcomes caused by underlying degenerative changes

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : top day surgery unit on Harley Street UK

Published article

: The presence of mild-to-moderate FS at L5-S1 was associated with more aggravated sagittal balance in terms of smaller preoperative disc height, larger sagittal vertical axis, smaller lumbar lordosis, and larger pelvic incidence-lumbar lordosis mismatch. Patients with L5-S1 FS also had poorer clinical outcomes including back pain and ODI score after L4-5 PLIF. Patients with L5-S1 FS need to be carefully examined before L4-5 fusion considering their adverse outcomes due to underlying…

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Spine J. 2024 Jan 12:S1529-9430(24)00001-9. doi: 10.1016/j.spinee.2023.12.006. Online ahead of print.ABSTRACTBACKGROUND CONTEXT: Patients scheduled for L4-5 PLIF often have FS at L5-S1. However, data on the clinical and radiographic outcomes of cases with mild-to-moderate L5-S1 FS are lacking, which may affect clinical outcomes or require additional surgery after L4-5 fusion.PURPOSE: To evaluate the clinical and,

Spine J. 2024 Jan 12:S1529-9430(24)00001-9. doi: 10.1016/j.spinee.2023.12.006. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Patients scheduled for L4-5 PLIF often have FS at L5-S1. However, data on the clinical and radiographic outcomes of cases with mild-to-moderate L5-S1 FS are lacking, which may affect clinical outcomes or require additional surgery after L4-5 fusion.

PURPOSE: To evaluate the clinical and radiographic outcomes of L4-5 PLIF in patients with and without mild-to-moderate L5-S1 FS, with a primary focus on the association between L5-S1 FS and postoperative clinical outcomes including back pain, leg pain, and scores on the Oswestry Disability Index (ODI) and EuroQol 5-Dimension (EQ-5D).

STUDY DESIGN: Retrospective comparative study PATIENT SAMPLE: : A retrospective review of patients who underwent L4-5 PLIF from 2014 to 2018. The patients were divided according to the presence of mild-to-moderate FS at L5-S1.

OUTCOME MEASURES: Clinical assessment included the pain visual analog scale (VAS), ODI, and EQ-5D score. Radiographic assessments included spinopelvic parameters and grades for central and foraminal stenosis.

METHODS: Clinical outcomes were assessed using validated outcome measures at preoperative, 6-month, 12-month, and 36-month follow-up visits. Radiographic evaluations were performed using preoperative and postoperative radiographs. Foraminal stenosis was assessed qualitatively using MRI with a grading system from none to severe and quantitatively by measuring changes in the foraminal area on CT.

RESULTS: Among 186 patients, 55 were categorized as the FS group and 131 as the non-FS group. The FS group was older (P=0.039) and had more severe central stenosis at L5-S1 (P=0.007) as well as more severe FS at both L4-5 and L5-S1 (both P<0.001). Preoperative disc height (P<0.001), C7-S1 sagittal vertical axis (P=0.003), lumbar lordosis (P=0.005), and pelvic incidence-lumbar lordosis mismatch (P=0.026) were more aggravated in the FS group. The FS group showed inferior clinical outcomes at the final follow-up in terms of back pain (P=0.010) and ODI score (P=0.003).

: The presence of mild-to-moderate FS at L5-S1 was associated with more aggravated sagittal balance in terms of smaller preoperative disc height, larger sagittal vertical axis, smaller lumbar lordosis, and larger pelvic incidence-lumbar lordosis mismatch. Patients with L5-S1 FS also had poorer clinical outcomes including back pain and ODI score after L4-5 PLIF. Patients with L5-S1 FS need to be carefully examined before L4-5 fusion considering their adverse outcomes due to underlying degenerative changes.

PMID:38219839 | DOI:10.1016/j.spinee.2023.12.006

The London Spine Unit : top day surgery unit on Harley Street UK

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Exploring the Impact of Mild-to-Moderate Foraminal Stenosis at L5-S1 on Clinical Outcomes Following L4-5 Posterior Lumbar Interbody Fusion

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Spine J. 2024 Jan 12:S1529-9430(24)00001-9. doi: 10.1016/j.spinee.2023.12.006. Online ahead of print.ABSTRACTBACKGROUND CONTEXT: Patients scheduled for L4-5 PLIF often have FS at L5-S1. However, data on the clinical and radiographic outcomes of cases with mild-to-moderate L5-S1 FS are lacking, which may affect clinical outcomes or require additional surgery after L4-5 fusion.PURPOSE: To evaluate the clinical and

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