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The Effect of Changes in Segmental Lordosis on Global Lumbar and Adjacent Segment Lordosis After L5-S1 Anterior Lumbar Interbody Fusion – Lumbar Fusion

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This article is a retrospective cohort study that examines the relationships between segmental, adjacent-level, and global lumbar lordosis following L5-S1 Anterior Lumbar Interbody Fusion (ALIF). The study found that patients with a certain degree of change in segmental lordosis showed increases in global lumbar lordosis but experienced losses in adjacent-level lordosis. The degree of compensatory loss of lordosis at the adjacent level correlated with the extent of segmental lordosis creation, suggesting that there may be a limit to the amount of lordosis that can be accommodated by the L4 to S1 segment. This information is important for understanding the potential effects of changes in segmental lordosis on adjacent and global lordosis

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSION: The degree of compensatory loss of lordosis at the adjacent level L4-L5 correlated with the extent of segmental lordosis creation at the index L5-S1 level. This may suggest that the L4 to S1 segment acts as a “harmonious unit,” able to accommodate only a certain amount of lordosis and further increases in segmental lordosis may be mitigated by loss of adjacent-level lordosis.

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Global Spine J. 2023 Aug 11:21925682231195777. doi: 10.1177/21925682231195777. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective Cohort Study.OBJECTIVE: Restoration of lordosis in lumbar fusion reduces low back pain, decreases adjacent segment degeneration, and improves postoperative outcomes. However, the potential effects of changes in segmental lordosis on adjacent-level and global lordosis remain less understood. This study aims to,

Global Spine J. 2023 Aug 11:21925682231195777. doi: 10.1177/21925682231195777. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective Cohort Study.

OBJECTIVE: Restoration of lordosis in lumbar fusion reduces low back pain, decreases adjacent segment degeneration, and improves postoperative outcomes. However, the potential effects of changes in segmental lordosis on adjacent-level and global lordosis remain less understood. This study aims to examine the relationships between segmental (SL), adjacent-level, and global lumbar lordosis following L5-S1 Anterior Lumbar Interbody Fusion (ALIF).

METHODS: 80 consecutive patients who underwent single-level L5-S1 ALIF were divided into 3 groups based on the degree of change (∆) in index-level segmental lordosis: <5° (n = 23), 5°-10° (n = 29), >10° (n = 28). Radiographic parameters measured included global lumbar, segmental, and adjacent level lordosis, sacral slope, pelvic tilt, pelvic incidence, and PI-LL mismatch.

RESULTS: Patients with ∆SL 5°-10° or ∆SL >10° both showed significant increases in global lumbar lordosis from preoperative to final follow-up. However, patients with ∆SL >10° showed statistically significant losses in adjacent level lordosis at both immediate postoperative and final follow-up compared to preoperative. When comparing patients with ∆SL >10° to those with ∆SL 5-10°, there were no significant differences in global lumbar lordosis at final follow-up, due to significantly greater losses of adjacent level lordosis in these patients.

CONCLUSION: The degree of compensatory loss of lordosis at the adjacent level L4-L5 correlated with the extent of segmental lordosis creation at the index L5-S1 level. This may suggest that the L4 to S1 segment acts as a “harmonious unit,” able to accommodate only a certain amount of lordosis and further increases in segmental lordosis may be mitigated by loss of adjacent-level lordosis.

PMID:37565994 | DOI:10.1177/21925682231195777

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The Effect of Changes in Segmental Lordosis on Global Lumbar and Adjacent Segment Lordosis After L5-S1 Anterior Lumbar Interbody Fusion

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Global Spine J. 2023 Aug 11:21925682231195777. doi: 10.1177/21925682231195777. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective Cohort Study.OBJECTIVE: Restoration of lordosis in lumbar fusion reduces low back pain, decreases adjacent segment degeneration, and improves postoperative outcomes. However, the potential effects of changes in segmental lordosis on adjacent-level and global lordosis remain less understood. This study aims to

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