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Validation of age-adjusted pelvic incidence minus lumbar lordosis and lordosis distribution index for assessing adjacent-segment disease after short-level lumbar fusion surgery: minimum 5 years of follow-up – Lumbar Fusion

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This article investigates the influence of sagittal alignment on the occurrence of adjacent-segment disease (ASD) after lumbar fusion surgery. The study analyzed data from 234 patients with lumbar degenerative diseases who underwent lumbar fusion surgery. The results showed that older age, 2-level fusion, worse preoperative pelvic tilt and lumbar lordosis, lower lordosis distribution index (LDI), and more improvement in sagittal vertical axis were significantly correlated with the occurrence of ASD. However, no significant differences were found in age-adjusted pelvic incidence minus lumbar lordosis (PI-LL) between ASD and non-ASD groups. The study concluded that age-adjusted PI-LL may have limited predictive ability for ASD development, while LDI and segmental lordosis were identified as important factors

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : innovative spine centre on Harley Street UK

Published article

S: Age-adjusted PI-LL may have limited ability to predict the development of ASD. LDI could exert an important effect on diagnosing the occurrence of ASD in the cases with low and average PI, but segmental lordosis was a more significant risk factor than LDI in individuals with high PI.

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J Neurosurg Spine. 2023 Nov 10:1-9. doi: 10.3171/2023.8.SPINE23393. Online ahead of print.ABSTRACTOBJECTIVE: The purpose of this study was to investigate the influence of sagittal alignment according to age-adjusted pelvic incidence minus lumbar lordosis (PI-LL) and lordosis distribution index (LDI) on the occurrence of adjacent-segment disease (ASD) after lumbar fusion surgery.METHODS: This study retrospectively reviewed 234,

J Neurosurg Spine. 2023 Nov 10:1-9. doi: 10.3171/2023.8.SPINE23393. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of this study was to investigate the influence of sagittal alignment according to age-adjusted pelvic incidence minus lumbar lordosis (PI-LL) and lordosis distribution index (LDI) on the occurrence of adjacent-segment disease (ASD) after lumbar fusion surgery.

METHODS: This study retrospectively reviewed 234 consecutive patients with lumbar degenerative diseases who underwent 1- or 2-level lumbar fusion surgery. Demographic and radiographic (preoperative and 3-month postoperative) data were collected and compared between ASD and non-ASD groups. Binary logistic regression analysis was performed to evaluate adjusted associations between potential variables and ASD development. A subanalysis was further conducted to assess their relationships in the range of different PI values.

RESULTS: With a mean follow-up duration of 70.6 months (range 60-121 months), 118 patients (50.4%) were diagnosed as having cranial radiological ASD. Univariate analyses showed that older age, 2-level fusion, worse preoperative pelvic tilt and LL, lower pre- and postoperative LDI, and more improvement in sagittal vertical axis were significantly correlated with the occurrence of ASD. No significant differences in the PI-LL and age-adjusted PI-LL (offset) were detected between ASD and non-ASD groups. Multivariate analysis identified postoperative LDI (OR 0.971, 95% CI 0.953-0.989, p = 0.002); 2-level fusion (OR 3.477, 95% CI 1.964-6.157, p < 0.001); and improvement of sagittal vertical axis (OR 0.992, 95% CI 0.985-0.998, p = 0.039) as the independent variables for predicting the occurrence of ASD. When stratified by PI, LDI was identified as an independent risk factor in the groups with low and average PI. Lower segmental lordosis (OR 0.841, 95% CI 0.742-0.954, p = 0.007) could significantly increase the incidence of ASD in the patients with high LDI.

S: Age-adjusted PI-LL may have limited ability to predict the development of ASD. LDI could exert an important effect on diagnosing the occurrence of ASD in the cases with low and average PI, but segmental lordosis was a more significant risk factor than LDI in individuals with high PI.

PMID:37948690 | DOI:10.3171/2023.8.SPINE23393

The London Spine Unit : innovative spine centre on Harley Street UK

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Validation of age-adjusted pelvic incidence minus lumbar lordosis and lordosis distribution index for assessing adjacent-segment disease after short-level lumbar fusion surgery: minimum 5 years of follow-up

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J Neurosurg Spine. 2023 Nov 10:1-9. doi: 10.3171/2023.8.SPINE23393. Online ahead of print.ABSTRACTOBJECTIVE: The purpose of this study was to investigate the influence of sagittal alignment according to age-adjusted pelvic incidence minus lumbar lordosis (PI-LL) and lordosis distribution index (LDI) on the occurrence of adjacent-segment disease (ASD) after lumbar fusion surgery.METHODS: This study retrospectively reviewed 234

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