Sagittal Balance and Spinopelvic Parameters Following Lateral Lumbar Interbody Fusion for Degenerative Scoliosis: A Case-Control Study.
Spine (Phila Pa 1976). 2013 Oct 21;
Authors: Baghdadi YM, Larson AN, Dekutoski MB, Cui Q, Sebastian AS, Armitage BM, Nassr A
Study Design. Retrospective matched-cohort analysis.Objective. To evaluate the change in radiographic parameters in patients undergoing interbody fusion and posterior instrumentation compared to posterior spine fusion alone (PSF) for degenerative scoliosis.Summary of Background Data. Little is known about the effect of lateral interbody fusion (LIF) on sagittal plane correction in the setting of degenerative scoliosis. We performed a retrospective study to investigate these changes compared to PSF.Methods. Between 1997 and 2011, 33 patients had LIF at 181 levels between T8 and L5 vertebrae for the treatment of degenerative scoliosis (mean; 5±2). Of those, 23 patients had additional anterior lumbar interbody fusion (ALIF) at 38 levels between L4 and S1 vertebrae (mean; 1.7±0.5). A 1:1 matched control of patients who underwent PSF was performed. Patients were matched by age, gender, and diagnosis. Clinical and radiographic data were collected and compared between the matched cohorts.Results. Lumbar lordosis was significantly restored in LIF±ALIF compared to PSF cohort (44º±14º versus 36º±15º,p = 0.02). The segmental lumbar lordosis over the 102 LIF levels significantly improved from 12°±10° to 21°±13° postoperatively (p<0.0001). However, the change over the 38 ALIF levels was not significant (from 30º±15º to 29º±9º,p = 0.8). Sagittal plane alignment was improved in LIF±ALIF compared to PSF cohort and trended toward but did not reach significance (3.8±3.2 cm versus 6.2±5.7 cm,p = 0.09). Sacral slope was significantly higher in LIF±ALIF compared to PSF cohort (33º±11º versus 28º±10º,p = 0.03). Pelvic tilt was lower in LIF±ALIF compared to PSF cohort and trended toward but did not reach significance (22º±10º versus 27º±10º,p = 0.08).Conclusion. Lumbar lordosis and sacral slope were mildly but statistically improved in the interbody fusion compared to PSF cohort. Sagittal alignment and pelvic tilt trended toward but did not reach statistical significance. Segmental lumbar lordosis was improved at LIF levels more so than at ALIF levels.
PMID: 24150436 [PubMed – as supplied by publisher]