Restoration of Segmental Lordosis and Related Factors in Interbody Fusion for Degenerative Lumbar Disease

Eung-Ha Kim; Jung-Moo Seo; Joong-Hyeon Ahn

doi:10.4184/jkss.2015.22.4.170

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Kim, Seo, and Ahn: Restoration of Segmental Lordosis and Related Factors in Interbody Fusion for Degenerative Lumbar Disease

Original Article

Journal of Korean Spine Surg 2015;22(4):170-177.

Published online: 21 December 2015

DOI: https://doi.org/10.4184/jkss.2015.22.4.170

Restoration of Segmental Lordosis and Related Factors in Interbody Fusion for Degenerative Lumbar Disease

Eung-Ha Kim, M.D., Jung-Moo Seo, M.D., Joong-Hyeon Ahn, M.D.

Department of Orthopaedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital

Corresponding author: Eung-Ha Kim, M.D. Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, 1174 Jung-Dong, Wonmi-Gu, Bucheon-Si, Gyeonggi-Do, 420-767, Korea TEL: +82-32-621-5259, FAX: +82-32-621-5016 E-mail: eungha@gmail.com

Received 18 August 201531 August 2015 Accepted 16 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 10° lordotic angle and PLIF used a metal cage with an 8° 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 4.67° before surgery, improved to 10.43° after surgery, and was 9.32° at the final followup. Comparing between the ALIF and PLIF at the L3-4 level in a similar number of patients revealed 7.24° and 4.61° 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.

Keywords: Degenerative lumbar disease, Interbody fusion, Segmental lordosis, Segmental flexibility, Fusion rate

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Figures and Tables%

Fig. 1.

The segmental angle is between the lower endplate of the upper vertebra body and upper endplate of the lower vertebra body. (A) preoperative, (B) postoperative.

Fig. 2.

The segmental lordosis angle was well restored after interbody fusion surgery.

Fig. 3.

The segmental lordosis angle was restored more successfully after ALIF surgery than PLIF surgery at the same L3-4 level.

Table 1.

Dermographic Characters of 43 Patients and 125 Levels

	Number of patients
Sex
Male	15 (34.8 %)
Female Age < 50 yrs	28 (65.2 %) 1 (2.3 %)
51-60 yrs	10 (23.2 %)
61-70 yrs	16 (37.2 %)
71-80 yrs	14 (32.5 %)
> 80 yrs	2 (4.6 %)
Diagnosis
Multilevel spinal stenosis	14 (32.6 %)
Adjacent segment degeneration	7 (16.3 %)
Traumatic kyphosis Pseudoarthrosis	3 (7.0 %) 8 (18.6 %)
Lumbar degenerative kyphosis	11 (25.6 %)
	Number of levels
ALIF level (48)
L1-2	7 (14.5 %)
L2-3	20 (41.6 %)
L3-4	19 (39.5 %)
L4-5 PLIF level (77)	2 (4.2 %)
L2-3	3 (3.8 %)
L3-4	16 (20.7 %)
L4-5	32 (41.5 %)
L5-S1	26 (33.8 %)
BMD	-2.1 (-4.7~0.6)
BMI	24.5(18.3~32.7)

Table 2.

Related Factors in Interbody Fusion for Degenerative Lumbar Disease (125 levels)

Variable		Poor Reduction (n=52)	Well Reduction (n=73)	Comparison (p-value)
Flexibility, n(%)	Rigid (<3º)	24 (46.15)	23 (31.51)	0.013 ^a
	Mobile (3º-10º)	26 (50)	34 (46.58)
	Hypermobile (>10º)	2 (3.85)	16 (21.92)
Disc space narrowing, n(%)	Severe (<1/3)	10 (19.23)	11 (15.07)	0.368 ^a
	Moderate (1/3-2/3)	15 (28.85)	30 (41.1)
	Mild (>2/3)	27 (51.92)	32 (43.84)
Claw spur, n(%)	(-)	35 (67.31)	52 (71.23)	0.785 ^b
	(+)	17 (32.69)	21 (28.77)
Vaccum disc, n(%)	(-)	39 (75)	47 (64.38)	0.286 ^b
	(+)	13 (25)	26 (35.62)

^a P-value was calculated by Cochran-Armitage trend test.

^b P-value was calculated by Chi-sqaure test.

Table 3.

Logistic Regression Analysis for Restorat Variable Flexibility Rigid ion of Segmental Lordosis Univariable Multivariable

Variable		Univariable			Multivariable
Variable		Crude OR	95% CI	p-value	Adjusted OR	95% CI	p-value
Flexibility	Rigid	1			1
	Mobile	1.36	(0.63-2.95)	0.427	1.45	(0.66-3.22)	0.361
	Hypermobile	8.35	(2.07-56.61)	0.008	8.89	(2.13-61.63)	0.008
Disc space narrowing	Severe (<1/3)	1			1
	Moderate (1/3-2/3)	1.82	(0.63-5.29)	0.268	1.96	(0.63-6.23)	0.247
	Mild (>2/3)	1.08	(0.39-2.94)	0.884	1.18	(0.4-3.6)	0.763
Claw spur	(-)	1			1
	(+)	0.83	(0.38-1.81)	0.638	0.82	(0.33-1.99)	0.665
Vaccum disc	(-)	1			1
	(+)	1.66	(0.76-3.73)	0.209	2.2	(0.9-5.64)	0.09

Abbreviation: OR, odds ratio: CI, confidence interval.

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