• Mark M Kodsy, Harvey E Freitag, Robert D Winkelman, Nicholas M Rabah, Bryan S Lee, Ryan Honomichl, Nicolas Thompson, Jason W Savage, R Douglas Orr, Edward C Benzel, and Iain H Kalfas.
• Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA. Electronic address: mkodsy@neomed.edu.
• World Neurosurg. 2022 Mar 1; 159: e399-e406.

ObjectiveTo determine whether the L3-L4 disc angle may be a surrogate marker for global lumbar alignment in thoracolumbar fusion surgery and to explore the relationship between radiographic and patient-reported outcomes after thoracolumbar fusion surgery.MethodsRetrospective chart review was conducted on patients who had undergone a lumbar fusion involving levels from T9 to pelvis. EuroQol-Five Dimension (EQ-5D-3L) scores and adverse events including adjacent-segment disease and degeneration, pseudoarthrosis, proximal junctional kyphosis, stenosis, and reoperation were collected. Pre- and postoperative spinopelvic parameters were measured on weight-bearing radiographs, with the L3-L4 disc angle of novel interest. Univariate logistic and linear regression were performed to assess the associations of radiographic parameters with adverse event incidence and improvement in EQ-5D-3L, respectively.ResultsIn total, 182 patients met inclusion criteria. Univariable analysis revealed that increased magnitude of L3-L4 disc angle, anterior pelvic tilt, and pelvic incidence measures are associated with increased likelihood of developing postoperative adverse events. Conversely, increased lumbar lordosis demonstrated a decreased incidence of developing a postoperative adverse event. Linear regression showed that radiographic parameters did not significantly correlate with postoperative EQ-5D-3L scores, although scores were significantly improved postfusion in all dimensions except Self-Care (P = 0.51).ConclusionsL3-L4 disc angle magnitude may serve as a surrogate marker of global lumbar alignment. The degree of spinopelvic alignment did not correlate to improvement in EQ-5D-3L score in the present study, suggesting that quality of life metric change may not be a sensitive or specific marker of postfusion alignment.Copyright © 2021 Elsevier Inc. All rights reserved.

14 keywords...

hide…