The Correlation between Restoration of Lumbar Lordosis and Surgical Outcome in the Treatment of Low-grade Lumbar Degenerative Spondylolisthesis with Spinal Fusion.
J Spinal Disord Tech. 2013 Dec 11;
Authors: Hsu HT, Yang SS, Chen TY
STUDY DESIGN:: Retrospective clinical study.
OBJECTIVE:: To investigate the relationship between the restoration of the lumbar lordosis (LL) and the surgical outcome of patients undergoing spinal fusion for low-grade lumbar degenerative spondylolisthesis.
SUMMARY OF BACKGROUND DATA:: Correlation between low back pain and the loss of LL in the treatment of low-grade lumbar degenerative spondylolisthesis has seldom been reported.
METHODS:: Between May, 2005 and July, 2011, 59 patients with low back pain and neurogenic claudication because of low-grade lumbar degenerative spondylolisthesis underwent spinal decompression and fusion by a senior surgeon. Ten patients were lost to follow-up. The mean age of the remaining 49 patients (10 men and 39 women) was 64.0 years (range: 47-88?y). Patients were categorized based on the spino-pelvic posture: Type 1 (pelvic incidence<45°) (n=12), Type 2 (45°?pelvic incidence?60°) (n=24), and Type 3 (pelvic incidence> 60°) (n=13). The LL restoration ratio was calculated by the actual LL divided by the predicted LL. The clinical results were evaluated using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Postoperative 36-inch spinal films were used to assess the sagittal balance.
RESULTS:: The mean follow-up period was 43.2 months (range: 28-62?mo). Forty-eight patients showed significant improvement with respect to VAS and ODI regardless of whether the LL was restored higher or lower. Postoperative 36-inch spinal films showed the C7 plumb line within an average of 4.4?cm (range: 0.6-5.6?cm) away from the posterior-superior corner of the S1 vertebrae.
CONCLUSION:: Patients with smaller pelvic incidence tended to be restored higher, and those patients with a larger pelvic incidence were more likely to be restored lower. For patients with normal sagittal balance, the surgical outcomes in the treatment of low-grade lumbar degenerative spondylolisthesis with spinal fusion are not correlated with restoration of the LL.
PMID: 24335721 [PubMed – as supplied by publisher]