Postoperative Flat Back: Contribution of Posterior Accessed Lumbar Interbody Fusion and Spinopelvic Parameters.
10.3340/jkns.2014.56.4.315
- Author:
Jin Kwon KIM
1
;
Byung Gwan MOON
;
Deok Ryeng KIM
;
Joo Seung KIM
Author Information
1. Department of Neurosurgery, Eulji General Hospital, College of Medicine, Eulji University, Seoul, Korea. nsdrmbg@hanmail.net
- Publication Type:Original Article
- Keywords:
Spinal curvatures;
Spinal fusion;
Postoperative complication;
Flat back
- MeSH:
Animals;
Constriction, Pathologic;
Diagnosis;
Humans;
Incidence;
Lordosis;
Pelvis;
Postoperative Complications;
Retrospective Studies;
Spinal Curvatures;
Spinal Fusion;
Spondylolisthesis
- From:Journal of Korean Neurosurgical Society
2014;56(4):315-322
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. METHODS: A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. RESULTS: A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance (R2=0.286, p=0.0005). CONCLUSION: Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back.
