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Kitaori T, Ota M, Tamura J. Bilateral L5 pedicle fracture with L5-S1 spondylolisthesis after single-level L4-5 posterior lumbar interbody fusion: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23279. [PMID: 37581583 PMCID: PMC10555588 DOI: 10.3171/case23279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Single-level posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) is a commonly performed surgical procedure for L4-5 isthmic spondylolisthesis. Postoperative L5 pedicle fracture with rapidly progressive spondylolisthesis at L5-S1 segment after L4-5 PLIF/TLIF is quite rare, and the etiology remains unclear. This report describes this rare complication and proposes a possible etiology focusing on the lumbosacral sagittal imbalance characterized by an anteriorly shifted lumbar loading axis. OBSERVATIONS The authors report a case complicated by L5 bilateral pedicle fractures and rapidly progressive spondylolisthesis at the L5-S1 segment very early after a single-level PLIF for L4-5 isthmic spondylolisthesis. Meyerding grade III anterolisthesis was observed at L5-S1 segment by 3 months after the initial surgery. Additional surgery was performed, and the fixation was extended to L4-ilium. Fracture healing was observed at 6 months postoperatively. LESSONS This complication may have been caused by abnormal local shear forces on the posterior neural arch of L5 vertebra and L5-S1 intervertebral disc, which were triggered by the fusion surgery for L4 shear-type spondylolisthesis. L4 sagittal vertical axis is considered a reasonable parameter representing lumbosacral sagittal imbalance with an anteriorly shifted loading axis and may be a candidate for the predictive parameters of this rare complication.
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Dalton JF, Fourman MS, Rynearson B, Wawrose R, Cluts L, Shaw JD, Lee JY. The L3 Flexion Angle Predicts Failure of Non-Operative Management in Patients with Tandem Spondylolithesis. Global Spine J 2023:21925682231161305. [PMID: 36881755 DOI: 10.1177/21925682231161305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Determine impact of standard/novel spinopelvic parameters on global sagittal imbalance, health-related quality of life (HRQoL) scores, and clinical outcomes in patients with multi-level, tandem degenerative spondylolisthesis (TDS). METHODS Single institution analysis; 49 patients with TDS. Demographics, PROMIS and ODI scores collected. Radiographic measurements-sagittal vertical axis (SVA), pelvic incidence (PI), lumbar lordosis (LL), PI-LL mismatch, sagittal L3 flexion angle (L3FA) and L3 sagittal distance (L3SD). Stepwise linear multivariate regression performed using full length cassettes to identify demographic and radiographic factors predictive of aberrant SVA (≥5 cm). Receiver operative curve (ROC) analysis used to identify cutoffs for lumbar radiographic values independently predictive of SVA ≥5 cm. Univariate comparisons of patient demographics, (HRQoL) scores and surgical indication were performed around this cutoff using two-way Student's t-tests and Fisher's exact test for continuous and categorical variables, respectively. RESULTS Patients with increased L3FA had worse ODI (P = .006) and increased rate of failing non-operative management (P = .02). L3FA (OR 1.4, 95% CI) independently predicted of SVA ≥5 cm (sensitivity and specifity of 93% and 92%). Patients with SVA ≥5 cm had lower LL (48.7 ± 19.5 vs 63.3 ± 6.9 mm, P < .021), higher L3SD (49.3 ± 12.9 vs 28.8 ± 9.2, P < .001) and L3FA (11.6 ± 7.9 vs -3.2 ± 6.1, P < .001) compared to patients with SVA ≤5 cm. CONCLUSIONS Increased flexion of L3, which is easily measured by the novel lumbar parameter L3FA, predicts global sagittal imbalance in TDS patients. Increased L3FA is associated with worse performance on ODI, and failure of non-operative management in patients with TDS.
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Affiliation(s)
- Jonathan F Dalton
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Pittsburgh Orthopaedic Spine Research Group (POSR), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mitchell S Fourman
- Pittsburgh Orthopaedic Spine Research Group (POSR), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Bronx, NY, USA
| | - Bryan Rynearson
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Pittsburgh Orthopaedic Spine Research Group (POSR), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Rick Wawrose
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Pittsburgh Orthopaedic Spine Research Group (POSR), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Landon Cluts
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Pittsburgh Orthopaedic Spine Research Group (POSR), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeremy D Shaw
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Pittsburgh Orthopaedic Spine Research Group (POSR), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joon Y Lee
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Pittsburgh Orthopaedic Spine Research Group (POSR), University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Luan H, Wang Y, Liu K, Sheng W, Deng Q. Efficacy of transforaminal lumbar interbody fusion in the treatment of double-level lumbar spondylolisthesis with sagittal imbalance. BMC Musculoskelet Disord 2022; 23:1038. [PMID: 36451156 PMCID: PMC9714229 DOI: 10.1186/s12891-022-06018-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To analyze the clinical efficacy of transforaminal lumbar interbody fusion (TLIF) in the treatment of continuous double-level lumbar spondylolisthesis with sagittal imbalance. METHODS The clinical data of 36 patients with double-level spondylolisthesis treated with TLIF were included and divided into L3/L4 double spondylolisthesis group and L4/L5 double spondylolisthesis group according to the site of spondylolisthesis. The sagittal parameters of the patients were measured by standing anteroposterior and lateral X-rays of the whole spine, and the visual analogue scale (VAS) for lumbar and lower limb pain, Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI) were recorded. The imaging parameters and clinical parameters of the patients before surgery, after surgery, and at the last follow-up were compared and statistically analyzed. RESULTS A total of 36 patients were included in the study and all had sagittal imbalance. Among them, there were 21 cases of L3 and L4 spondylolisthesis, 6 males and 15 females, with an average age of 64.7 ± 9.4 years; there were 15 cases of L4 and L5 spondylolisthesis, 4 males and 11 females, with an average age of 66.5 ± 8.0 years. 36 patients completed the operation, the operation time was 190.28 ± 6.12 min, and intraoperative blood loss was 345 ± 11 ml. Compared with preoperative, there were significant differences in SVA, TPA, T1-SPi, LL, PT, SS, PI-LL, SD, SA, and SP between patients after surgery and at the last follow-up (P < 0.05). Compared with preoperative, VAS score, JOA score, and ODI index of waist and lower limbs were significantly improved after the operation and at the last follow-up, and there was a significant difference (P < 0.05). CONCLUSION TLIF can effectively relieve the symptoms of patients with continuous double-level lumbar spondylolisthesis, restore lumbar lordosis and sagittal spinal sequence, and improve the quality of life of patients.
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Affiliation(s)
- Haopeng Luan
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
| | - Yao Wang
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
| | - Kai Liu
- grid.412631.3Department of Trauma and Microreconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
| | - Weibin Sheng
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
| | - Qiang Deng
- grid.412631.3Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054 Xinjiang China
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Beschloss A, Dicindio C, Lombardi J, Varthi A, Ozturk A, Lehman R, Lenke L, Saifi C. Marked Increase in Spinal Deformity Surgery Throughout the United States. Spine (Phila Pa 1976) 2021; 46:1402-1408. [PMID: 33769412 DOI: 10.1097/brs.0000000000004041] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort database study. OBJECTIVE The aim of this study was to investigate trends in utilization and demographics in Spinal Deformity Surgery. SUMMARY OF BACKGROUND DATA The aging population in the United States will likely result in increased incidence of adult degenerative scoliosis. With a national focus on resource utilization and value-based care, it is essential for surgeons, researchers, and health care policy makers to know utilization and demographic trends of spinal surgery with long fusion construct. METHODS The National Inpatient Sample (NIS) database was queried for patients who underwent fusion or refusion of nine or more vertebrae (ICD-9-CM 81.64) between 2004 and 2015 across 44 states. Demographic and economic data include annual number of surgeries, incidence, patient age, sex, region, insurance type, charge, routine discharge, length of stay, and data. The NIS database represents a 20% sample of discharges from US hospitals, excluding rehabilitation and long-term acute care hospitals, which is weighted to provide national estimates. RESULT In 2014, there were 14,615 fusions involving nine or more vertebrae across the United States. The number of fusions involving nine or more levels has increased 141% from 6072 in 2004. Long fusion constructs increased 460% from 2004 to 2014 among patients 65 to 84 years' old. The mean hospital cost associated with long fusion spine surgery was $69,546 per case in 2015. Between 2004 and 2014, the payer breakdown for individuals receiving spinal deformity surgery is as follows: 54.2% private insurance, 18% Medicare, and 21.2% Medicaid. CONCLUSION The massive increase (141%) in utilization of long construct spine fusion was primarily driven by 460% rise in incidence of the surgery among those aged 65 to 84. Although the cause is unknown, it is possible that this rise was, at least in part, driven by the implementation of the affordable care act, improved surgical safety, and better knowledge of spinopelvic parameters.Level of Evidence: 3.
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Affiliation(s)
- Alexander Beschloss
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, The Spine Center at Pennsylvania Hospital, University of Pennsylvania Hospital System, Philadelphia, PA
| | - Christina Dicindio
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, The Spine Center at Pennsylvania Hospital, University of Pennsylvania Hospital System, Philadelphia, PA
| | - Joseph Lombardi
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY
| | - Arya Varthi
- Department of Orthopaedic Surgery, Yale School of Medicine, New Haven, CT
| | - Ali Ozturk
- Department of Neurological Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ronald Lehman
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY
| | - Lawrence Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY
| | - Comron Saifi
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, The Spine Center at Pennsylvania Hospital, University of Pennsylvania Hospital System, Philadelphia, PA
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Li Z, Chen DJ, Liu Z, Tang B, Zhong Y, Li G, Wan Z. Motion characteristics of the lower lumbar spine in individuals with different pelvic incidence: An in vivo biomechanical study. Clin Biomech (Bristol, Avon) 2021; 88:105419. [PMID: 34303068 DOI: 10.1016/j.clinbiomech.2021.105419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 06/20/2021] [Accepted: 06/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pelvic incidence is the quantification of the pelvis anatomical shape which has significant effect on the occurrence of various lumbar degenerative diseases. The aim of this study was to measure the in vivo dynamic motion characteristics of the lower lumbar spine in people with different pelvic incidence. METHODS A total of 55 volunteers were included in the study. The participants were devided into 3 groups (A: pelvic incidence≤40°, B: 40° < pelvic incidence <60° and C: pelvic incidence ≥60°). The L3-S1 vertebrae of each subject was MRI scanned to construct 3D models. The lumbar spine was then imaged using a dual fluoroscopic imaging system as the subject performed physiological position. The 3D vertebral models and the fluoroscopic images were used to reproduce the in vivo vertebral positions along the motion path. The relative translations and rotations of each motion segment were analyzed. FINDINGS At the L5-S1 segment, the primary ranges of motion for left-right axial rotation and flexion-extension of the patients with large pelvic incidence (3.28° ± 0.79°, 7.56° ± 1.81°) were significantly larger than normal pelvic incidence (2.61° ± 1.01°, 6.57° ± 2.18°) and small pelvic incidence (2.00° ± 0.60°, 5.83° ± 1.67°). INTERPRETATION The anatomic variable pelvic incidence is associated with the ranges of motion in lower lumbar vertebrae, especially in the L4-5 and L5-S1 segments.
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Affiliation(s)
- Zhiyun Li
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China
| | - De-Jian Chen
- Department of Orthopedics, The Affiliated Nanjing Jiangbei Hospital of Nantong University, Nanjing, Jiangsu 210048, PR China
| | - Zhang Liu
- The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China
| | - Benyu Tang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China
| | - Yanlong Zhong
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China
| | - Guoan Li
- Bioengineering Lab, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit St., GRJ 1215, Boston, MA 02114, USA.
| | - Zongmiao Wan
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi, PR China.
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Azimi P, Yazdanian T, Benzel EC, Montazeri A. Global Sagittal Balance of Spine in Asymptomatic Controls: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 154:93-108. [PMID: 34314909 DOI: 10.1016/j.wneu.2021.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the global sagittal balance of spine (GSBS) in asymptomatic controls. METHODS PubMed, Scopus, Cochrane library, and Web of Science searched up to July 2020. Studies were screened for the GSB parameters including T1 pelvic angle (TPA), spinosacral angle (SSA), sagittal vertical axis (SVA), C7/sacrofemoral distance ratio (Barrey index), odontoid hip axis (OD-HA), and Full Balance Index (FBI) as measured in asymptomatic participants. A meta-analysis was performed to synthesize pooled estimates. Heterogeneity and publication bias were assessed. RESULTS Overall, 76 studies were identified including 12,169 participants (54.7% female) with mean age ranges from 12.0 to 72.9 years old. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the mean (standard deviation) normative values were: 1) age ˃18 years, SSA (°), 127.6 (0.89); SVA absolute value (millimeters), 13.1 (1.13); TPA (°), 9.8 (1.13); T1SPI (°), -4.3 (0.57); and Barrey index absolute value, 0.51 (0.3). The mean value of the OD-HA (°) was reported 2.9 (1.6), and the FBI average value was less than 5°. 2) Age ≤18 years, SSA (°), 132.1 (8.3); SVA absolute value (millimeters), 11.9 (2.0); and Barrey index, -0.7 (8.3). A significant difference was observed between the 2 age groups based on SVA and SSA. CONCLUSIONS This paper presents normative data on TPA, SSA, SVA, Barrey index, OD-HA, and FBI as a reference for evaluating/measuring a GSB of spine in asymptomatic controls.
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Affiliation(s)
- Parisa Azimi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Edward C Benzel
- Cleveland Clinic Foundation, Department of Neurosurgery, Cleveland, Ohio, USA
| | - Ali Montazeri
- Mental Health Research Group, Health Metrics Research Centre, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
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Harada GK, Khan JM, Vetter C, Basques BA, Sayari AJ, Hayani Z, Tchalukov K, Louie PK, Colman M, An HS. Does the Number of Levels Fused Affect Spinopelvic Parameters and Clinical Outcomes Following Posterolateral Lumbar Fusion for Low-Grade Spondylolisthesis? Global Spine J 2021; 11:116-121. [PMID: 32875855 PMCID: PMC7734270 DOI: 10.1177/2192568220901527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES To determine how the number of fused intervertebral levels affects radiographic parameters and clinical outcomes in patients undergoing open posterolateral lumbar fusion (PLF) for low-grade degenerative spondylolisthesis. METHODS This was a retrospective cohort study on patients who underwent open PLF for low-grade spondylolisthesis at a single institution from 2011 to 2018. Patients were divided into groups based on number of levels fused during their procedure (1, 2, or 3 or more). Preoperative and postoperative spinopelvic radiographic parameters, patient-reported outcomes (Visual Analog Scale [VAS]-back, VAS-leg, Oswestry Disability Index [ODI]), and postoperative complications were compared. RESULTS Of the 316 patients eligible (203 one-level, 95 two-level, 18 three or more levels), change in initial postoperative to final pelvic incidence-lumbar lordosis was greatest in 2-level fusions (P = .039), while 3 or more level fusions had worse final pelvic tilt measures (P = .021). In addition, multilevel fusions had worse final VAS-back scores (2-level: P = .015; 3 or more levels: P = .011), higher rates of dural tears (2-level: P = .001), reoperation (2-level: P = .039), and discharge to facility (3 or more levels: P = .047) when compared with 1-level fusions. CONCLUSIONS Patients in multilevel fusions experienced less improvement in back pain, had more complications, and were more commonly discharged to a facility compared with single-level PLF patients. These findings are important for operative planning, for setting appropriate preoperative expectations, and for risk stratification in patients undergoing posterior lumbar fusion for low-grade spondylolisthesis.
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Affiliation(s)
| | | | | | - Bryce A. Basques
- Rush University Medical Center, Chicago, IL, USA,Bryce A. Basques, Rush University Medical Center, 1611 W Harrison St, Suite 300, Chicago, IL 60612, USA.
| | | | - Zayd Hayani
- Rush University Medical Center, Chicago, IL, USA
| | | | | | | | - Howard S. An
- Rush University Medical Center, Chicago, IL, USA
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Poonia A, Lodha S, Sharma NC. Evaluation of spinopelvic parameters in lumbar prolapsed intervertebral disc. Indian J Radiol Imaging 2020; 30:253-262. [PMID: 33273757 PMCID: PMC7694732 DOI: 10.4103/ijri.ijri_49_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/10/2020] [Accepted: 06/14/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Sacro-pelvic morphology and orientation are usually described in terms of pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). Orientation and morphology of pelvis can affect degenerative changes in the lumbar spine. Thus, here we investigated the relationships between various sagittal spinopelvic parameters and the degree of disc degeneration in young adults. Material and Methods: A hospital-based cross-sectional study with a total of 60 cases was done. Patients presenting with back or leg pain having prolapsed disc on magnetic resonance imaging (MRI) were included in the study. A standing X-ray of LS spine from dorso-lumbar junction to mid-thigh was taken. Various spinopelvic parameters were assessed from the scannogram using the software. Results: The mean age was 39.27 years. L5S1 was the most common level. Mean SS, PT, PI, and LL were 37.78°, 13.52°, 51.33°, and 41.01°. Disc pathologies at L1L2, L2L3, and L4L5 level showed a positive correlation with PT, PI, and LL. Disc pathology at the L5S1 level shows a positive correlation with PT and LL. A statistically significant correlation between SS and degenerative spondylolisthesis at L4L5 was found from data with P = 0.023. Discussion: An increase in SS statistically significantly increases the chance of development of degenerative spondylolisthesis at L4L5. An increase in PT, PI, and LL will cause an increase in disc pathology at L1L2. An increase in SS, PT, PI, and LL will cause an increase in disc pathology at L2L3. An increase in SS, PT, PI, and LL will cause an increase in disc pathology at L4L5. An increase in PT and LL will cause an increase in disc pathology at L5S1. Conclusion: Standing lateral view radiograph from dorso-lumbar junction to the mid-thigh is as good as standing whole spine radiograph for measurement of spinopelvic parameters. Degenerative spondylolisthesis at L4L5 has a statistically significant correlation with an increase in SS.
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Affiliation(s)
- Apoorva Poonia
- Department of Radiology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Sambhav Lodha
- Department of Radiology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - N C Sharma
- Department of Radiology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
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Iwamura Y, Inasaka R, Fujimaki H, Kouno M, Aota Y. Clinical and radiological features of lumbar degenerative spondylolisthesis who complicates osteoarthritis of the knee. J Orthop Sci 2020; 25:800-804. [PMID: 31767532 DOI: 10.1016/j.jos.2019.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/10/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND DATA Correlation between lumbar degenerative disease and degenerative disorders of the knee joint have often been reported, however, detailed research concerning lumbar degenerative spondylolisthesis (DS) who complicates osteoarthritis of the knee (KOA) are scarce. METHODS A total of 184 consecutive surgically treated DS patients were identified, and divided into two groups: DS patients who complicate KOA (KOA group) and DS patients without KOA (non-KOA group). DS was defined as grade 1 or more, according to Meyerding's classification, and KOA was defined as grade 3 or more according to Kellgren-Lawrence classification. Clinical and the radiological differences of DS patients between KOA group and non-KOA group were investigated in order to clarify the features of DS patients who complicate KOA. Statistical significance using student's t-test and multivariate logistic regression analysis was performed to identify independent predictors of complicating KOA in DS. RESULTS KOA group and non-KOA group consisted of 57 and 127 patients, respectively, with both group predominantly of female patients. Clinical features of KOA group were significantly high in age and body mass index (BMI), and more likely to complicate circulatory system disorders than non-KOA group. Radiological features of KOA group were significantly high in frequency of double adjacent level spondylolisthesis, Pelvic incidence (PI), Pelvic tilt (PT), and PI-LL. Multivariate logistic regression analysis identified coexistence of circulatory system disorders (OR 2.251, p = 0.024) and PI-LL (OR 1.04, p < 0.001) to be an independent predictors of complicating KOA in DS patients. CONCLUSIONS Older age and overweighted female patients coexistence of circulatory system disorders, containing double adjacent level spondylolisthesis with high PI, PT, and PI-LL were the characteristics of DS patients who complicate KOA, particularly coexistence of circulatory system disorders and significantly high lumbo-pelvic sagittal mismatch were the most significant factors above all.
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Affiliation(s)
- Yuichi Iwamura
- Department of Orthopaedic Surgery, Yokohama Ekisaikai Hospital, Yokohama, Japan.
| | - Riki Inasaka
- Department of Orthopaedic Surgery, Yokohama Ekisaikai Hospital, Yokohama, Japan
| | - Hiroshi Fujimaki
- Department of Orthopaedic Surgery, Yokohama Municipal Hospital, Yokohama, Japan
| | - Motonori Kouno
- Department of Orthopaedic Surgery, Yokohama Ekisaikai Hospital, Yokohama, Japan
| | - Youichi Aota
- Department of Orthopaedic Surgery, Yokohama Brain, Neurology and Spine Center, Yokohama, Japan
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Takahashi Y, Okuda S, Nagamoto Y, Matsumoto T, Sugiura T, Iwasaki M. Effect of segmental lordosis on the clinical outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis. J Neurosurg Spine 2019; 31:670-675. [PMID: 31299642 DOI: 10.3171/2019.4.spine181463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although the importance of spinopelvic sagittal balance and its implications for clinical outcomes of spinal fusion surgery have been described, to the authors' knowledge there have been no reports of the relationship between spinopelvic alignment and clinical outcomes for 2-level posterior lumbar interbody fusion (PLIF). The purpose of this study was to elucidate the relationship between clinical outcomes and spinopelvic sagittal parameters after 2-level PLIF for 2-level degenerative spondylolisthesis (DS). METHODS This study was limited to patients who were treated with 2-level PLIF for 2-level DS at L3-4-5. Between 2005 and 2014, 33 patients who could be followed up for at least 2 years were included in this study. The average age at the time of surgery was 72 years, and the average follow-up period was 5.6 years. Based on clinical assessments, the Japanese Orthopaedic Association (JOA) score and recovery rate were evaluated. The patients were divided into 2 groups based on the recovery rate: the good outcome group (G group; n = 19), with recovery rate ≥ 50%, and the poor outcome group (P group; n = 14) with recovery rate < 50%. Spinopelvic parameters were measured using lateral standing radiographs of the whole spine as follows: sagittal vertical axis (SVA), thoracic kyphosis (TK), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), and segmental lordosis (SL) at L3-4-5. The clinical outcomes and radiological parameters were assessed preoperatively and at the final follow-up. Radiological parameters were compared between the 2 groups. RESULTS The mean JOA score improved significantly in all patients from 10.8 points before surgery to 19.6 points at the latest follow-up (mean recovery rate 47.7%). For radiological outcomes, no difference was observed from preoperative assessment to final follow-up in any of the spinopelvic parameters except SVA. Although no significant difference between the 2 groups was detected in any of the spinopelvic parameters, there were significant differences in the change in SL and LL (ΔSL 3.7° vs -2.1° and ΔLL 1.2° vs -5.6° for the G and P groups, respectively). In addition, the number of patients in the G group was significantly larger for the patients with ΔSL-plus than those with ΔSL-minus (p = 0.008). CONCLUSIONS The clinical outcomes of 2-level PLIF for 2-level DS limited at L3-4-5 appeared to be satisfactory. The results indicate that acquisition of increased SL in surgery might lead to better clinical outcomes.
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Affiliation(s)
| | - Shinya Okuda
- 1Department of Orthopaedic Surgery, Osaka Rosai Hospital; and
| | | | | | - Tsuyoshi Sugiura
- 2Department of Orthopaedic Surgery, Japan Community Health Care Organization, Osaka Hospital, Osaka, Japan
| | - Motoki Iwasaki
- 1Department of Orthopaedic Surgery, Osaka Rosai Hospital; and
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Du CZ, Li S, Xu L, Zhou QS, Zhu ZZ, Sun X, Qiu Y. Sagittal reconstruction of lumbosacral contiguous double-level spondylolytic spondylolisthesis: a comparison of double-level and single-level transforaminal lumbar interbody fusion. J Orthop Surg Res 2019; 14:148. [PMID: 31122245 PMCID: PMC6533736 DOI: 10.1186/s13018-019-1197-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/14/2019] [Indexed: 12/24/2022] Open
Abstract
Background Contiguous double-level lumbar spondylolytic spondylolisthesis is an extremely rare condition. There is a paucity of data of lumbosacral deformity and sagittal spino-pelvic malalignment among these patients. Moreover, the effect of transforaminal lumbar interbody fusion (TLIF) on sagittal realignment still remains largely unknown. The aim of the study is to investigate the reconstruction of sagittal alignment and the improvement of clinical outcomes after posterior instrumented double-level or single-level TLIF. Methods From January 2010 to September 2018, the records of patients with contiguous L4/5 and L5/S1 double-level spondylolytic spondylolisthesis were retrospectively reviewed. Patients who had undergone double-level or single-level TLIF and a minimum of 2 years’ follow-up were included. The slippage parameters and spino-pelvic parameters were measured preoperatively, postoperatively, and at the latest follow-up. Results A total of 58 patients (21 males and 37 females, mean age of 57.1 ± 6.9 years) were enrolled. Thirty-eight patients were treated with double-level TLIF and the remaining 20 with single-level TLIF (L4/5 in 14; L5/S1 in 6). After surgery, the spondylolisthesis was significantly reduced at both L4/5 and L5/S1 level (all P < 0.001). There was a significant reduction in pelvic tilt (P < 0.001) and a significant increase in sacral slope (P < 0.001). Significant increase in L4–S1 height (P < 0.001) and L4–S1 lordosis (P = 0.012) and decrease in L5 slope (P = 0.004) and L5 incidence (P = 0.001) were also observed. Compared to single-level TLIF, double-level TLIF increased L4–S1 height (P < 0.001) and L4–S1 lordosis (P < 0.001) and reduced L4-SVA (P = 0.007) and L5 incidence (P = 0.013) more obviously, and the sagittal balance was better corrected in double-level TLIF group (P = 0.006). Double-level TLIF group showed larger increase in VAS scores for low back pain. The incidence of implant-related complications was lower in the double-level group. Conclusion Posterior short-segment instrumented TLIF can bring favorable radiographic and clinical outcomes in patients with lumbosacral contiguous double-level spondylolytic spondylolisthesis. Double-level TLIF is more efficient to improve L4–S1 height, regional lumbar lordosis, and global sagittal balance.
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Affiliation(s)
- Chang-Zhi Du
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China
| | - Song Li
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Liang Xu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Qing-Shuang Zhou
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China
| | - Ze-Zhang Zhu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, Jiangsu, China
| | - Xu Sun
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China.
| | - Yong Qiu
- Department of Spine Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Zhongshan Road 321, Nanjing, 210008, China.
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Zhang J, Hai Y, Yang J, Pan A, Zhang Y. Increased PT/SS may play an important role in the pathogenesis of lumbar spondylolisthesis with degenerative lumbar scoliosis. Clin Neurol Neurosurg 2018; 166:23-30. [PMID: 29358108 DOI: 10.1016/j.clineuro.2018.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 01/08/2018] [Accepted: 01/15/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To explore the clinical and spinopelvic features in patients with lumbar spondylolisthesis and degenerative lumbar scoliosis (LSDLS) and those with standalone lumbar spondylolisthesis (SALS). PATIENTS AND METHODS We retrospectively analyzed 130 patients with lumbar spondylolisthesis seen between 05/2013 and 12/2016 in our hospital. Propensity score matching was used to reduce an age distribution imbalance between the two groups. Clinical and spinopelvic parameters were compared by independent samples t test and chi-square test. Nonlinear binary logistic regression analysis was used to analyze the independent factors. RESULTS There was no significant difference between groups for body mass index, level of intercrest line, level of spondylolisthesis, grade of spondylolisthesis, sagittal translation, segmental angulation, thoracic kyphosis, or sagittal vertical axis. The LSDLS group had significantly lower lumbar lordosis (LL) than the SALS group. The LSDLS group showed significantly greater pelvic tilt (PT) and ratio of PT to SS (sacral slope) (PT/SS), and lower SS. The pelvic incidence (PI) was not significantly different. The LSDLS group showed stronger significant differences in PT/SS compared to the SALS group. With each 0.1 increase in PT/SS, the risk of LSDLS increased 1.465 times. CONCLUSIONS Patients with spondylolysis are less prone to development of DLS. Lower LL and SS, and higher PT are associated with the occurrence of LSDLS. Increased PT/SS may play an important role in the pathogenesis of LSDLS.
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Affiliation(s)
- Jinlei Zhang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, China; Department of Orthopedics, Zhoukou City Central Hospital, Xinxiang Medical University, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, China.
| | - Jincai Yang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, China
| | - Aixing Pan
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, China
| | - Yangpu Zhang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, China
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Samuel AM, Moore HG, Cunningham ME. Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence. Curr Rev Musculoskelet Med 2017; 10:521-529. [PMID: 28994028 DOI: 10.1007/s12178-017-9442-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Current guidelines for the optimal treatment degenerative spondylolisthesis are weak and based on limited high-quality evidence. RECENT FINDINGS There is some moderate evidence that decompression alone may be a feasible treatment with lower surgical morbidity and similar outcomes to fusion when performed in a select population with a low-grade slip. Similarly, addition of interbody fusion may be best suited to a subset of patients with high-grade degenerative spondylolisthesis, although this remains controversial. Minimally invasive techniques are increasingly being utilized for both decompression and fusion surgeries with more and more studies showing similar outcomes and lower postoperative morbidity for patients. This will likely be an area of continued intense research. Finally, the role of spondylolisthesis reduction will likely be determined as further investigation into optimal sagittal balance and spinopelvic parameters is conducted. Future identification of ideal thresholds for sagittal vertical axis and slip angle that will prevent progression and reoperation will play an important role in surgical treatment planning. Current evidence supports surgical treatment of degenerative spondylolisthesis. While posterolateral spinal fusion remains the treatment of choice, the use of interbodies and decompressions without fusion may be efficacious in certain populations. However, additional high-quality evidence is needed, especially in newer areas of practice such as minimally invasive techniques and sagittal balance correction.
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Affiliation(s)
- Andre M Samuel
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Harold G Moore
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Matthew E Cunningham
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
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