Journal List > J Korean Soc Spine Surg > v.11(3) > 1035614

Jeon, Kim, Chung, Kim, and Yi: The Changes of Sagittal Alignment after Anterior Interbody Fusion with Posterior Fixation in Spondylolisthesis of the Lumbar Spine

Abstract

Study Design

A prospective radiological assessment was conducted.

Objectives

To analyze the changes in the height of the intervertebral disc, the slippage, slip angle, lumbar lordotic angle and sacral inclination after anterior lumbar interbody fusion and posterior pedicle screw fixation in a lumbar spondylolisthesis.

Summary of Literature Review

The anterior lumbar interbody fusion causes changes in the lumbar sagittal alignment.

Methods

The mini- open anterior lumbar interbody fusion and pedicle screw fixation was undertaken in 33 cases from A pril 1995 to November 2003. MRI was done before and 6 months after surgery. The measuring factors were the heights of the intervertebral disc, slippage, slip angle, lumbar lordotic angle and sacral inclination. The measuring factors were independently assessed three times by three different orthopedic surgeons. The postoperative changes in measuring the factors were analyzed by a paired t- test statistically.

Results

The height of the intervertebral disc was increased by a mean of 14.0%, slippage was reduced by a mean of 2.8%, the slip angle was reduced by a mean of 16.0%, the lumbar lordotic angle was increased by a mean of 15.6% and the scaral inclination was increased by a mean of 3.0%. There was significance in the increase in the disc height, the reduction of slippage and the slip angle, and the increase in lumbar lordotic angle, but there were no significance regarding the changes in sacral inclination.

Conclusions

The anterior lumbar interbody fusion and the pedicle screw fixation significantly improved the height of the intervertebral disc, slippage, slip angle, and lumbar lordotic angle, except sacral inclination.

REFERENCES

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Figures and Tables%

Fig. 1.
Radiological measurement of disc height.
jkss-11-131f1.tif
Fig. 2.
Radiological measurment of slip percentage.
jkss-11-131f2.tif
Fig. 3.
Radiological measurment of slip angle (c).
jkss-11-131f3.tif
Fig. 4.
Radiological measurment of lumbar lordotic angle(d) and sacral inclination(e).
jkss-11-131f4.tif
Fig. 5.
A 61-year-old woman with degenerative spondylolisthesis L4 on L5. (A) sagittal image of level of the midportion of vertebral body on preoperative MRI shows 12.4% in disc height rate, 3.4% in slip, 8.5° in slip angle, 15.2° in lumbar lordotic angle,42.4° in sacral inclination. (B) sagittal image of level of the midportion of vertebral body on postoperative MRI shows 47.1% in disc height rate, 1.2% in slip, 0.8° in slip angle, 20.1° in lumbar lordotic angle, 38.9° in sacral inclination.
jkss-11-131f5.tif
Fig. 6.
A 48-year-old woman with isthmic spondylolisthesis L4 on L5. (A) sagittal image of level of the midportion of vertebral body on preoperative MRI shows 19.1% in disc height rate, 3% in slip, 0.8° in slip angle, 36.2° in lumbar lordotic angle, 44.0° in sacral inclination. (B) sagittal image of level of the midportion of vertebral body on postoperative MRI shows 36.1% in disc height rate, 1.3% in slip, 1.9° in slip angle, 32.4° in lumbar lordotic angle, 36.5° in sacral inclination.
jkss-11-131f6.tif
Table 1.
Patients data
Isthmic type Degenerative type
Number of cases 16 17
Mean Age (years) 50 61
Gender (M:F) 3 : 13 3 : 14
Slip level
 L3 1 4
 L4 10 11
 L5 5 2
Meyerding grade
 I 14 15
 II 2 2
Taillard (%) 11.96 8.78
Followup of MRI* (months) 27.1 21.4
Radiologic union (months) 5.4 6.2

: Magnetic Resonance Image

Table 2.
Radiological measurements of preoperative and postoperative parameters
preop postop p-value
disc height rate (%) 19.6 33.6 0.000
slip (Taillard %) 10.3 7.6 0.000
slip angle (°) 6.5 5.6 0.012
lumar lordosis (°) 31.4 37.2 0.015
sacral inclination (°) 41.9 42.9 0.341
Table 3.
Rate of postoperative changes of radiological parameters
disc height restoration
 (postop disc height rate-preop disc height rate)
14.0%
slip reduction
 preop % slip-postop % slip)
2.8%
slip angle correction rate
 ((postop SA*-preop SA*)/postop SA*100)
16.0%
lumar lordosis change
 ((postop LA**-preop LA**)/postop LA*100)
15.6%
sacral inclination change
 ((postop SI -preop SI)/postop SI*100)
3.0%

: Slip angle,

: Lordotic angle,

: Sacral inclination

Table 4.
Comparison of isthmic type and degenerative type
Isthmic type Degenerative type
disc heght rate
 preop(%) 20.1 21.1
 postop(%) 36.8 32.8
disc height restoration(%) 16.7 11.7
slip
 preop(%) 8.8 12.0
 postop(%) 5.9 9.3
slip reduction(%) 2.9 2.7
slip angle
 preop(°) 6.4 6.8
 postop(°) 5.4 5.9
 slip angle correction rate 18.5 15.2
lordotic angle
 preop(°) 27.3 32.8
 postop(°) 38.1 35.9
 lumar lordosis change 28.3 8.6
sacral inclination
 preop(°) 42.5 41.2
 postop(°) 43.9 41.8
 sacral inclination change 4.0 2.0
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