Abstract
Background Context
Lateral lumbar interbody fusion (LLIF) is an effective technique for fusion and sagittal
alignment correction/maintenance. Studies have investigated the impact on the segmental
angle and lumbar lordosis (and pelvic incidence-lumbar lordosis mismatch), however
not much is documented regarding the immediate compensation of the adjacent angles.
Purpose
To evaluate acute adjacent and segmental angle as well as lumbar lordosis changes
in patients undergoing a L3–4 or L4–5 LLIF for degenerative pathology.
Study Design/Setting
Retrospective cohort study.
Patient Sample
Patients included in this study were analyzed pre- and post-LLIF performed by one
of three fellowship-trained spine surgeons, 6 months following surgery.
Outcome Measures
Patient demographics (including body mass index, diabetes diagnosis, age, and sex)
as well as VAS and ODI scores were measured. Lateral lumbar radiograph parameters:
lumbar lordosis (LL), segmental lordosis (SL), infra and supra-adjacent segmental
angle, and pelvic incidence (PI).
Methods
Multiple regressions were applied for the main hypothesis tests. We examined any interactive
effects at each operative level and used the 95% confidence intervals to determine
significance: a confidence interval excluding zero indicates a significant effect.
Results
We identified 84 patients who underwent a single level LLIF (61 at L4–5, 23 at L3–4).
For both the overall sample and at each operative level, the operative segmental angle
was significantly more lordotic postop compared to preop (all ps≤.01). Adjacent segmental
angles were significantly less lordotic postop compared to pre-op overall (p=.001).
For the overall sample, greater lordotic change at the operative segment led to more
compensatory reduction of lordosis at the supra-adjacent segment. At L4–5, more lordotic
change at the operative segment led to more compensatory lordosis reduction at the
infra-adjacent segment.
Conclusion
The present study demonstrated that LLIF resulted in significant increase in operative
level lordosis and a compensatory decrease in supra- and infra-adjacent level lordosis,
and subsequently no significant impact on spinopelvic mismatch.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Spine JournalAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis.Spine J. 2016; 16https://doi.org/10.1016/j.spinee.2015.07.001
- Correlation analysis of sagittal alignment and skeletal muscle mass in patients with spinal degenerative disease.Sci Rep. 2018; 8 (Accessed February 12, 2023)https://doi.org/10.1038/s41598-018-33867-0
- Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: A prospective multicenter analysis.Spine (Phila Pa 1976). 2013; 38 (Accessed February 12, 2023)https://doi.org/10.1097/BRS.0b013e318292b7b9
- Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects.Eur Spine J. 2016; 25 (Accessed February 12, 2023)https://doi.org/10.1007/s00586-016-4702-2
- Relationship between sagittal balance and adjacent segment disease in surgical treatment of degenerative lumbar spine disease: meta-analysis and implications for choice of fusion technique.Eur Spine J. 2018; 27 (Accessed February 12, 2023)https://doi.org/10.1007/s00586-018-5629-6
- Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: A radiographic study - Clinical article.J Neurosurg Spine. 2011; 15 (Accessed February 12, 2023)https://doi.org/10.3171/2011.3.SPINE10425
- Sagittal alignment as a risk factor for adjacent level degeneration: A case-control study.Orthopedics. 2008; 31 (Accessed February 12, 2023)https://doi.org/10.3928/01477447-20080601-08
- Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion.Eur Spine J. 2001; 10 (Accessed February 12, 2023)https://doi.org/10.1007/s005860000239
- Effects of Restoration of Sagittal Alignment on Adjacent Segment Degeneration in Instrumented Lumbar Fusions.Spine (Phila Pa 1976). 2020; 45 (Accessed February 12, 2023)https://doi.org/10.1097/BRS.0000000000003682
- Adequate Restoration of Disc Height and Segmental Lordosis by Lumbar Interbody Fusion Decreases Adjacent Segment Degeneration.World Neurosurg. 2018; 118 (Accessed February 12, 2023)https://doi.org/10.1016/j.wneu.2018.07.075
- Comparison of Segmental Lordosis and Global Spinopelvic Alignment After Single-Level Lateral Lumbar Interbody Fusion or Transforaminal Lumbar Interbody Fusion.World Neurosurg. 2019; 126 (Accessed February 12, 2023)https://doi.org/10.1016/j.wneu.2019.03.106
- Restoring spinopelvic harmony with lateral lumbar interbody fusion: Is it a realistic goal?.J Spine Surg. 2020; 6 (Accessed February 12, 2023)https://doi.org/10.21037/jss-20-605
- The role of minimally invasive lateral lumbar interbody fusion in sagittal balance correction and spinal deformity.Eur Spine J. 2014; 23 (Accessed February 12, 2023)https://doi.org/10.1007/s00586-014-3561-y
- Direct lateral lumbar interbody fusion for degenerative conditions: Early complication profile.J Spinal Disord Tech. 2009; 22 (Accessed February 12, 2023)https://doi.org/10.1097/BSD.0b013e3181679b8a
- A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: Perioperative outcomes and complications.Spine (Phila Pa 1976). 2010; 35 (Accessed February 12, 2023)https://doi.org/10.1097/BRS.0b013e3182022e04
- The impact of interbody approach and lumbar level on segmental, adjacent, and sagittal alignment in degenerative lumbar pathology: a radiographic analysis 6 months following surgery.Spine J. 2022; (Accessed February 12, 2023)https://doi.org/10.1016/j.spinee.2022.03.010
- A Multicenter Radiographic Evaluation of the Rates of Preoperative and Postoperative Malalignment in Degenerative Spinal Fusions.Spine (Phila Pa 1976). 2018; 43 (Accessed February 12, 2023)https://doi.org/10.1097/BRS.0000000000002500
- Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion.Eur Spine J. 2015; 24 (Accessed February 12, 2023)https://doi.org/10.1007/s00586-014-3454-0
- Adjacent Segment Degeneration after Short-Segment Lateral Lumbar Interbody Fusion (LLIF).Biomed Res Int. 2022; 2022 (Accessed February 12, 2023)https://doi.org/10.1155/2022/5161503
- Adult spinal deformity-postoperative standing imbalance: How much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery.Spine (Phila Pa 1976). 2010; 35 (Accessed February 12, 2023)https://doi.org/10.1097/BRS.0b013e3181ee6bd4
- Changes in sagittal alignment following short-level lumbar interbody fusion: Comparison between posterior and lateral lumbar interbody fusions.Asian Spine J. 2019; 13 (Accessed February 12, 2023)https://doi.org/10.31616/asj.2019.0011
- Does approach matter? A comparative radiographic analysis of spinopelvic parameters in single-level lumbar fusion.Spine J. 2018; 18 (Accessed February 12, 2023)https://doi.org/10.1016/j.spinee.2018.03.014
- Changes in segmental and lumbar lordosis after lateral lumbar interbody fusion with different lordotic cage angulations.Int J Spine Surg. 2021; 15 (Accessed February 12, 2023)https://doi.org/10.14444/8066
- Preservation or Restoration of Segmental and Regional Spinal Lordosis Using Minimally Invasive Interbody Fusion Techniques in Degenerative Lumbar Conditions.Spine (Phila Pa 1976). 2016; 41 (Accessed February 12, 2023)https://doi.org/10.1097/BRS.0000000000001470
- Do Lordotic Cages Provide Better Segmental Lordosis Versus Nonlordotic Cages in Lateral Lumbar Interbody Fusion (LLIF)?.Clin Spine Surg. 2017; 30 (Accessed February 12, 2023)https://doi.org/10.1097/BSD.0000000000000114
- Analysis of the Factors Affecting Lumbar Segmental Lordosis after Lateral Lumbar Interbody Fusion.Spine (Phila Pa 1976). 2020; 45 (Accessed February 12, 2023)https://doi.org/10.1097/BRS.0000000000003432
- Does interbody cage lordosis impact actual segmental lordosis achieved in minimally invasive lumbar spine fusion?.Neurosurg Focus. 2020; 49 (Accessed February 12, 2023)https://doi.org/10.3171/2020.6.FOCUS20393
- Prognostic Factors for Adjacent Segment Disease after L4-L5 Lumbar Fusion.Neurosurgery. 2020; 86 (Accessed February 12, 2023)https://doi.org/10.1093/neuros/nyz241
Article info
Publication history
Published online: March 07, 2023
Accepted:
February 27,
2023
Received in revised form:
February 24,
2023
Received:
November 14,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable.
Author disclosures: LK: Nothing to disclose. CED: Nothing to disclose. JS: Nothing to disclose. JCAL: Nothing to disclose. VMN: Consulting: Medtronic (B); Speaking/Teaching Arrangements: Nuvasive (B), Medtronic (B), Stryker (B). ESV: Nothing to disclose. PKL: Nothing to disclose.
There was no funding accepted for this study.
IRB Approval: IRB 21-004.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
