Restoration of Segmental Lordosis and Related Factors in Interbody Fusion for Degenerative Lumbar Disease.
10.4184/jkss.2015.22.4.170
- Author:
Eung Ha KIM
1
;
Jung Moo SEO
;
Joong Hyeon AHN
Author Information
1. Department of Orthopaedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, Korea. eungha@gmail.com
- Publication Type:Original Article
- Keywords:
Degenerative lumbar disease;
Interbody fusion;
Segmental lordosis;
Segmental flexibility;
Fusion rate
- MeSH:
Animals;
Follow-Up Studies;
Humans;
Lordosis*;
Osteophyte;
Pliability;
Retrospective Studies;
Spondylolisthesis
- From:Journal of Korean Society of Spine Surgery
2015;22(4):170-177
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
STUDY DESIGN: A retrospective study. OBJECTIVES: To analyze restoration of segmental lordosis and factors related to interbody fusion and the fusion rate with degenerative lumbar disease. SUMMARY OF LITERATURE REVIEW: Few studies have addressed the restoration of segmental lordosis and factors related to interbody fusion for degenerative lumbar disease. MATERIALS AND METHODS: Records of 43 patients treated by anterior lumbar interbody fusion (ALIF) or posterior lumbar interbody fusion (PLIF) surgery from 2011 to 2013 were reviewed. ALIF used a metal cage with a 10degrees lordotic angle and PLIF used a metal cage with an 8degrees lordotic angle. Preoperative, postoperative, and at least 1 year outcomes were analyzed from radiographs. As a related factor, segmental flexibility, disc height, osteophytes, vaccuum disc, hypertrophic facet, spondylolisthesis, and endplate violation were analyzed. We also analyzed the bony union rate. RESULTS: The segmental lordotic angle was 4.67degrees before surgery, improved to 10.43degrees after surgery, and was 9.32degrees at the final follow-up. Comparing between the ALIF and PLIF at the L3-4 level in a similar number of patients revealed 7.24degrees and 4.61degrees restoration after ALIF and PLIF surgery, postoperatively. The difference was statistically significant (p=0.011). Segmental flexibility had a statistically significant positive correlation (p=0.013). Lower disc height and osteophytes limited restoration of segmental lordosis, but vaccuum disc was restored well after interbody fusion. Bony union was achieved in 92.8% of the cases. CONCLUSIONS: Intebody fusion, especially ALIF surgery, results in acceptable restoration of segmental lordosis. Even with narrowed disc space or osteophytes, remained segmental flexibility is an important factor of segmental lordosis restoration.