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Becker L, Mihalache TV, Schmidt H, Putzier M, Pumberger M, Schömig F. Influences of lumbo-sacral transitional vertebrae for anterior lumbar interbody fusion. Sci Rep 2024; 14:2746. [PMID: 38302558 PMCID: PMC10834422 DOI: 10.1038/s41598-024-53179-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/29/2024] [Indexed: 02/03/2024] Open
Abstract
Lumbo-sacral transitional vertebrae (LSTV) are frequent congenital variances of the spine and are associated with increased spinal degeneration. Nevertheless, there is a lack of data whether bony alterations associated with LSTV result in reduced segmental restoration of lordosis when performing ALIF. 58 patients with monosegmental stand-alone ALIF in the spinal segment between the 24th and 25th vertebra (L5/S1)/(L5/L6) where included. Of these, 17 patients had LSTV and were matched to a control population by age and sex. Pelvic incidence, pelvic tilt, sagittal vertical axis, lumbar lordosis, segmental lordosis, disc height and depth were compared. LSTV-patients had a significantly reduced segmental lordosis L4/5 (p = 0.028) and L5/S1/(L5/L6) (p = 0.041) preoperatively. ALIF resulted in a significant increase in segmental lordosis L5/S1 (p < 0.001). Postoperatively, the preoperatively reduced segmental lordosis was no longer significantly different in segments L4/5 (p = 0.349) and L5/S1/(L5/6) (p = 0.576). ALIF is associated with a significant increase in segmental lordosis in the treated segment even in patients with LSTV. Therefore, ALIF is a sufficient intervention for restoring the segmental lordosis in these patients as well.
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Affiliation(s)
- Luis Becker
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Augustenburger Pl. 1, 13353, Berlin, Germany.
| | - Tim Victor Mihalache
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Augustenburger Pl. 1, 13353, Berlin, Germany
| | - Hendrik Schmidt
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Augustenburger Pl. 1, 13353, Berlin, Germany
| | - Michael Putzier
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Friederike Schömig
- Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité-Universitätsmedizin Berlin, Augustenburger Pl. 1, 13353, Berlin, Germany
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Tung KK, Tseng WC, Wu YC, Chen KH, Pan CC, Lu WX, Shih CM, Lee CH. Comparison of radiographic and clinical outcomes between ALIF, OLIF, and TLIF over 2-year follow-up: a comparative study. J Orthop Surg Res 2023; 18:158. [PMID: 36864438 PMCID: PMC9979469 DOI: 10.1186/s13018-023-03652-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/26/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Regarding the increasing adoption of oblique lateral interbody fusion (OLIF) for treating degenerative lumbar disorders, we aimed to evaluate whether OLIF, one of the options for anterolateral approach lumbar interbody fusion, demonstrate clinical superiority over anterior lumbar interbody fusion (ALIF) or posterior approach, represented by transforaminal lumbar interbody fusion (TLIF). METHODS Patients who received ALIF, OLIF, and TLIF for symptomatic degenerative lumbar disorders during the period 2017-2019 were identified. Radiographic, perioperative, and clinical outcomes were recorded and compared during 2-year follow-up. RESULTS A total of 348 patients with 501 correction levels were enrolled in the study. Fundamental sagittal alignment profiles were substantially improved at 2-year follow-up, particularly in the anterolateral approach (A/OLIF) group. The Oswestry disability index (ODI) and EuroQol-5 dimension (EQ-5D) in the ALIF group were superior when compared to the OLIF and TLIF group 2-year following surgery. However, comparisons of VAS-Total, VAS-Back, and VAS-Leg revealed no statistically significance across all approaches. TLIF demonstrated highest subsidence rate of 16%, while OLIF had least blood loss and was suitable for high body mass index patients. CONCLUSIONS Regarding treatment for degenerative lumbar disorders, ALIF of anterolateral approach demonstrated superb alignment correction and clinical outcome. Comparing to TLIF, OLIF possessed advantage in reducing blood loss, restoring sagittal profiles and the accessibility at all lumbar level while simultaneously achieving comparable clinical improvement. Patient selection in accordance with baseline conditions, and surgeon preference both remain crucial issues circumventing surgical approach strategy.
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Affiliation(s)
- Kuan-Kai Tung
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Cheng Tseng
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yun-Che Wu
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kun-Hui Chen
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan ,grid.411432.10000 0004 1770 3722Department of Biomedical Engineering, Hung Kuang University, Taichung, Taiwan ,grid.412550.70000 0000 9012 9465Department of Computer Science and Information Engineering, Providence University, Taichung, Taiwan ,Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Chien-Chou Pan
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan ,Department of Rehabilitation Science, Jenteh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Wen-Xian Lu
- Department of Orthopedics, Feng Yuan Hospital Ministry of Health and Welfare, Taichung, Taiwan
| | - Cheng-Min Shih
- grid.410764.00000 0004 0573 0731Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan ,grid.411432.10000 0004 1770 3722Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan. .,Post Baccalaureate Medicine, School of Medicine, National Chung Hsing University, Taichung, Taiwan. .,Department of Food Science and Technology, Hung Kuang University, Taichung, Taiwan.
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Tung KK, Chen KH, Pan CC, Lee CH. Letter to the editor regarding, "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" by O'Connor et al. Spine J 2022; 22:1585. [PMID: 35988949 DOI: 10.1016/j.spinee.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
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Dong S, Li J, Jia X, Zhu J, Chen Y, Yuan B, Nisar S. Analysis of Risk Factors for Adjacent Segment Degeneration after Minimally Invasive Transforaminal Interbody Fusion at Lumbosacral Spine. Computational Intelligence and Neuroscience 2022; 2022:1-8. [PMID: 35498212 PMCID: PMC9050292 DOI: 10.1155/2022/4745534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/15/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022]
Abstract
Background. Adjacent segment degeneration (ASD) has been considered as a serious complication from changes in the biological stress pattern after spinal fusion. The sagittal balance significantly associated with lumbar loading is largely dependent on L5-S1 segment. However, the evidence indicating risk factors for radiological and symptomatic ASD after minimally invasive transforaminal interbody fusion (MIS-TLIF) remains insufficient. Methods. This single-central retrospective study recruited patients with lumbosacral degeneration receiving MIS-TLIF at the L5-S1 level from January 2015 to December 2018. The targeted variables included demographic information, radiological indicators, surgery-related parameters, and patient-reported outcomes (PROs) extracted from the electronic medical system by natural language processing. In these patients, a minimum of 3-year follow-up was done. After reviewing the preoperative and postoperative follow-up digital radiographs, patients were assigned to radiological ASD group (disc height narrowing ≥3 mm, progressive slipping ≥3 mm, angular motion >10°, and osteophyte formation >3 mm), symptomatic ASD group, and control group. We identified potential predictors for radiological and symptomatic ASD with the service of stepwise logistic regression analysis. Results. Among the 157 consecutive patients treated with MIS-TLIF in our department, 16 cases (10.2%) were diagnosed with radiological ASD at 3-year follow-up. The clinical evaluation did not reveal suspicious risk factors, but several significant differences were confirmed in radiological indicators. Multivariate logistic regression analysis showed postoperative PI, postoperative DA, and ∆PI-LL in radiological ASD group were significantly different from those in control group. Nevertheless, for patients diagnosed with simultaneously radiological and symptomatic ASD, postoperative DA and postoperative PT as risk factors significantly affected the clinical outcome following MIS-TLIF. Conclusion. In this study, while approximately 10% of lumbosacral degenerations develop radiographic ASD, prognosis-related symptomatic ASD was shown not to be a frequent postoperative complication. Postoperative PI, postoperative DA, and mismatched PI-LL are risk factors for radiological ASD, and postoperative DA and postoperative PT are responsible for the occurrence of symptomatic ASD following MIS-TLIF. These radiological risk factors demonstrate that restoration of normal sagittal balance is an effective measure to optimize treatment strategies for secondary ASD prevention.
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