What is the early fate of adjacent segmental lordosis compensation at L3-4 and L5-S1 following a lateral versus transforaminal lumbar Interbody Fusion at L4-5?

Autor: Kim M; Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA.; School of Medicine, University of Washington, Seattle, WA, USA., Kumar R; Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA., Drolet CE; Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA., Bs MA; Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA., Hanks T; Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA.; School of Medicine, University of Washington, Seattle, WA, USA., Yamaguchi K; Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA.; School of Medicine, University of Washington, Seattle, WA, USA., Krause K; Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA., Nemani VM; Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA., Leveque JC; Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA., Louie PK; Department of Neurosurgery, Center for Neurosciences and Spine, Virginia Mason Franciscan Health, 1100 Ninth Ave., Seattle, WA, 98101, USA. Louie.philip@gmail.com.
Jazyk: angličtina
Zdroj: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J] 2024 Sep; Vol. 33 (9), pp. 3503-3508. Date of Electronic Publication: 2024 Jul 04.
DOI: 10.1007/s00586-024-08384-6
Abstrakt: Introduction: Degenerative spondylolisthesis causes translational and angular malalignment, resulting in a loss of segmental lordosis. This leads to compensatory adjustments in adjacent levels to maintain balance. Lateral lumbar interbody fusion (LLIF) and transforaminal lumbar interbody fusion (TLIF) are common techniques at L4-5. This study compares compensatory changes at adjacent L3-4 and L5-S1 levels six months post LLIF versus TLIF for grade 1 degenerative spondylolisthesis at L4-5.
Methods: A retrospective study included patients undergoing L4-5 LLIF or TLIF with posterior pedicle screw instrumentation (no posterior osteotomy) for grade 1 spondylolisthesis. Pre-op and 6-month post-op radiographs measured segmental lordosis (L3-L4, L4-L5, L5-S1), lumbar lordosis (LL), and pelvic incidence (PI), along with PI-LL mismatch. Multiple regressions were used for hypothesis testing.
Results: 113 patients (61 LLIF, 52 TLIF) were studied. TLIF showed less change in L4-5 lordosis (mean = 1.04°, SD = 4.34) compared to LLIF (mean = 4.99°, SD = 5.53) (p = 0.003). L4-5 angle changes didn't correlate with L3-4 changes, and no disparity between LLIF and TLIF was found (all p > 0.16). In LLIF, greater L4-5 lordosis change predicted reduced compensatory L5-S1 lordosis (p = 0.04), while no significant relationship was observed in TLIF patients (p = 0.12).
Conclusion: LLIF at L4-5 increases lordosis at the operated level, with compensatory decrease at L5-S1 but not L3-4. This reciprocal loss at adjacent L5-S1 may explain inconsistent improvement in lumbar lordosis (PI-LL) post L4-5 fusion.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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