• World Neurosurg · Oct 2018

    Adequate Restoration of Disc Height and Segmental Lordosis by Lumbar Interbody Fusion Decreases Adjacent Segment Degeneration.

    • Haijun Tian, Aimin Wu, Mingke Guo, Kai Zhang, Chen Chen, Xunlin Li, Xiaofei Cheng, Tangjun Zhou, Samuel S Murray, Xiaojiang Sun, and Jie Zhao.
    • Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
    • World Neurosurg. 2018 Oct 1; 118: e856-e864.

    ObjectiveThis study aimed to investigate the effects of lumbar interbody fusion-induced biomechanical changes on the adjacent segments, especially disc height and segmental lordosis restoration, and to provide more information for proper surgical strategy selection.MethodsThe medical records of 528 patients who underwent posterior lumbar interbody fusion were retrospectively reviewed, and a total of 89 patients were included. Surgical indications included degenerative spondylolisthesis (nonspondylolytic), marked disc herniation, or lumbar spinal stenosis requiring extensive decompression at L4/5. Postoperative adjacent segment degeneration (ASD) was assessed based on X-rays and functional status. Disc height, foraminal height, segmental lordosis, lumbar lordosis, and cage geometry were compared between the ASD and non-ASD patients. To identify the possible risk factors for radiographic ASD, univariate analysis was performed first, followed by multivariate logistic regression using variables with P < 0.20.ResultsUnivariate analysis revealed that the postoperative disc height in the non-ASD group were significantly greater than in the ASD group. The postoperative segmental lordosis in the non-ASD group was significantly greater than that in the ASD group, and the lumbar lordosis in the non-ASD group was also significantly greater than that in the ASD group at the final follow-up visit. Four variables were identified as independent risk factors for ASD by subsequent multivariate logistic regression: postoperative relative disc height of L4/5 (P = 0.011), postoperative segmental lordosis (P = 0.046), lumbar lordosis at the final follow-up visit (P = 0.007), and cage height (P = 0.038).ConclusionsImproved lumbar lordosis is correlated with a lower incidence of ASD, and adequate disc height and segmental lordosis restoration are essential for ASD prevention.Copyright © 2018 Elsevier Inc. All rights reserved.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…