A Comparative Radiographic Analysis of Fusion Rate between L4-5 and L5-S1 in a Single Level Posterior Lumbar Interbody Fusion.
10.14245/kjs.2015.12.2.60
- Author:
Sang Hyun HAN
1
;
Seung Jae HYUN
;
Tae Ahn JAHNG
;
Ki Jeong KIM
Author Information
1. Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. kijeong@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Spinal fusion;
Lumbosacral region;
Retrospective studies
- MeSH:
Animals;
Classification;
Follow-Up Studies;
Humans;
Lordosis;
Lumbosacral Region;
Retrospective Studies;
Risk Factors;
Spinal Fusion
- From:Korean Journal of Spine
2015;12(2):60-67
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: This study aimed to investigate radiographic fusion rates at L4-5 and L5-S1 after single level posterior lumbar interbody fusion (PLIF) and evaluate the relationship between fusion rates and preoperative disc slope angle (DSA), lumbar lordosis (LL), segmental angle (SA), and pelvic parameters. METHODS: We conducted a retrospective review of patients who underwent single level PLIF at L4-5 or L5-S1 during May 2003-December 2012 at our institution. 73 patients were finally enrolled. Fusion was assessed by use of the Brantigan-Steffee classification, less than 2mm translation and less than 5degrees motion on the flexion-extension lateral radiographs. We analyzed the radiographic fusion rates, risk factors, and relationship of fusion rates with DSA, LL, SA, and pelvic parameters. RESULTS: There were 59 patients (80.8%) in the L4-5 group and 14 (19.2%) in L5-S1 (average follow-up, 34 months). The radiographic fusion rates were 89.8% in the L4-5 group (53/59) and 42.9% in L5-S1 (6/14) (p<0.001).The preoperative DSA was significantly lesser in the L4-5 group than in the L5-S1 group (13.1+/-8.1degrees vs. 27.2+/-6.7degrees, p<0.001). The LL, SA, and pelvic parameters were not related with radiographic fusion rates in both groups. Risk factors for non-union were not identified between the two groups except for the surgery level (p<0.001). CONCLUSION: The radiographic fusion rate at L5-S1 was less than half that at L4-5 after single level PLIF. This may be due to the anatomical and biomechanical differences between the two levels. More vigorous effort to achieve successful fusion at L5-S1 should be considered.
