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- Title
Postoperative change in lumbopelvic alignment after short-segment transforaminal lumbar interbody fusion is related to preoperative postural difference in lumbar lordosis.
- Authors
Aoki, Yasuchika; Inoue, Masahiro; Takahashi, Hiroshi; Nakajima, Arata; Sonobe, Masato; Terajima, Fumiaki; Nakajima, Takayuki; Sato, Yusuke; Kubota, Go; Sato, Masashi; Yoh, Satoshi; Ohyama, Shuhei; Saito, Junya; Norimoto, Masaki; Eguchi, Yawara; Orita, Sumihisa; Inage, Kazuhide; Shiga, Yasuhiro; Ohtori, Seiji; Nakagawa, Koichi
- Abstract
Postoperative changes in lumbar lordosis (LL) after transforaminal lumbar interbody fusion (TLIF) and the related factors are not well-understood. Recently, the preoperative difference in LL between standing and supine positions (DiLL) was proposed as a factor for predicting postoperative radiologic outcomes after short-segment TLIF. This study investigated the influence of DiLL on mid-term radiological outcomes after short-segment TLIF. Sixty-six patients with lumbar degenerative disease treated with short-segment TLIF (1–2 levels) who underwent lumbar spine standing radiographs at 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years postoperatively were divided into DiLL (+) and DiLL (−) groups (preoperative DiLL ≥0° and <0°, respectively). Associations between the postoperative change in LL and DiLL and clinical outcomes (Oswestry disability index (ODI) and Nakai score) were evaluated. Temporary restoration of LL (+4.5°) until 1 year postoperatively and a subsequent decrease in LL from 1 to 5 years postoperatively (−5.3°) was observed in the DiLL (+) group. No postoperative change in LL was observed in the DiLL (−) group. Postoperative changes in LL were mainly observed in non-fused segments. The postoperative change in LL (ΔLL) until 1 year postoperatively had a significant positive association with DiLL (p = 0.00028), whereas ΔLL from 1 to 5 years postoperatively showed a significant negative association with DiLL (p = 0.010) and a positive association with Nakai score (p = 0.028). ΔLL until 5 years postoperatively showed a significant positive association with postoperative ODI improvement (p = 0.011). DiLL (+) patients showed a specific time course with temporary LL restoration until 1 year postoperatively and a subsequent decrease in LL from 1 to 5 years postoperatively. Patients with larger postoperative increase in LL until 5 years postoperatively and lesser decrease in LL from 1 to 5 years postoperatively tended to show better mid-term clinical outcomes.
- Subjects
LORDOSIS; SPINAL surgery; LUMBAR vertebrae; SUPINE position; STANDING position; SPINAL fusion; DEGENERATION (Pathology)
- Publication
Journal of Orthopaedic Science, 2023, Vol 28, Issue 2, p321
- ISSN
0949-2658
- Publication type
Article
- DOI
10.1016/j.jos.2021.11.020