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Influence of pelvic incidence-lumbar lordosis mismatch on surgical outcomes of short-segment transforaminal lumbar interbody fusion

Overview of attention for article published in BMC Musculoskeletal Disorders, August 2015
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Title
Influence of pelvic incidence-lumbar lordosis mismatch on surgical outcomes of short-segment transforaminal lumbar interbody fusion
Published in
BMC Musculoskeletal Disorders, August 2015
DOI 10.1186/s12891-015-0676-1
Pubmed ID
Authors

Yasuchika Aoki, Arata Nakajima, Hiroshi Takahashi, Masato Sonobe, Fumiaki Terajima, Masahiko Saito, Kazuhisa Takahashi, Seiji Ohtori, Atsuya Watanabe, Takayuki Nakajima, Makoto Takazawa, Sumihisa Orita, Yawara Eguchi, Koichi Nakagawa

Abstract

The importance of pelvic incidence-lumbar lordosis (PI-LL: PI minus LL) mismatch is emphasized in long-segment fusion for adult spinal deformity; however, there are few studies evaluating the influence of PI-LL on surgical outcomes after short-segment fusion. In this study, we have examined the effects of PI-LL mismatch on surgical outcomes of short-segment lumbar intervertebral fusion for lumbar degenerative diseases. Patients with lumbar degenerative disease treated by short-segment (1 or 2 levels) transforaminal lumbar interbody fusion were divided into Group A (PI-LL ≤ 10°: n = 22) and Group B (PI-LL ≥ 11°: n = 30). Pre-and post-operative patient symptoms were assessed by the visual analogue scale (VAS: scores 0-100 mm; for LBP, lower-extremity pain, and lower-extremity numbness), a detailed VAS for LBP while in motion, standing, and sitting, and the Oswestry disability index (ODI). Surgical outcomes were evaluated by the Nakai score (3 = excellent to 0 = poor. Post-operative data were acquired for at least one year following surgery and were compared between the two groups. Multiple regression analyses were used to evaluate the relative influence of PI-LL on each pre-and post-operative parameter (VAS, detailed VAS and ODI) adjusted for age, sex, fusion levels, body mass index, presence of scoliosis, diabetes mellitus and depression. The surgical outcomes in Group A were significantly better than those of Group B. Group A showed better post-operative VAS scores for LBP, particularly LBP while standing (11.9 vs. 25.8). The results of the multivariate analyses showed no significant correlation between PI-LL and pre-operative symptoms, but did show a significant correlation between PI-LL and the post-operative VAS score for LBP, lower extremity pain, and numbness. This study is the first to find that PI-LL mismatch influences post-operative residual symptoms, such as LBP, lower extremity pain and numbness. Among the three types of LBP examined in the detailed VAS, LBP while standing was most strongly related to PI-LL mismatch. The importance of maintaining spinopelvic alignment is emphasized, particularly when treating patients with adult spinal deformity using long-segment fusion surgery. However, our results indicate that surgeons should pay attention to sagittal spinopelvic alignment and avoid post-operative PI-LL mismatch even when treating patients with short-segment lumbar interbody fusion.

Mendeley readers

The data shown below were compiled from readership statistics for 85 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 3 4%
Denmark 2 2%
United Kingdom 1 1%
Spain 1 1%
Unknown 78 92%

Demographic breakdown

Readers by professional status Count As %
Researcher 22 26%
Unspecified 19 22%
Other 10 12%
Student > Master 9 11%
Student > Bachelor 7 8%
Other 18 21%
Readers by discipline Count As %
Medicine and Dentistry 42 49%
Unspecified 28 33%
Engineering 5 6%
Psychology 4 5%
Biochemistry, Genetics and Molecular Biology 2 2%
Other 4 5%