Correlation of Adjacent Segmental Disease with Tilt Angles of the Upper and Lower Instrumented Vertebra in the Degenerative Lumbar Scoliosis

Jun-Young Yang; June-Kyu Lee; Yong-Bum Joo; Soo-Min Cha; Jun-Yeong Park

doi:10.4184/JKSS.2021.20.1.1

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Yang, Lee, Joo, Cha, and Park: Correlation of Adjacent Segmental Disease with Tilt Angles of the Upper and Lower Instrumented Vertebra in the Degenerative Lumbar Scoliosis

Original Research

J Korean Soc Spine Surg 2013;20(1):1-7.

Published online: 18 March 2013

DOI: https://doi.org/10.4184/JKSS.2021.20.1.1

Correlation of Adjacent Segmental Disease with Tilt Angles of the Upper and Lower Instrumented Vertebra in the Degenerative Lumbar Scoliosis

Jun-Young Yang, M.D., June-Kyu Lee, M.D., Yong-Bum Joo, M.D., Soo-Min Cha, M.D., Jun-Yeong Park, M.D.

Department of Orthopedic Surgery, Chungnam National University, School of Medicine, Daejeon, Korea

Corresponding author: Jun-Young Yang, M.D. Department of Orthopedic Surgery, Chungnam National University, School of Medicine, 640 Daesa-dong, Jung-Gu Daejeon 301-040, Korea, TEL: 82-42-220-7531, FAX: 82-42-252-7098 E-mail: jyyang@cnu.ac.kr

Received 9 October 201113 December 2011 Accepted 5 October 2012

“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

Retrospective study.

Objectives

To evaluate the correlation of adjacent segmental disease with tilt angles of the upper and lower instrumented vertebra after instrumented posterolateral fusion for degenerative lumbar scoliosis.

Summary of Literature Review

There has been no study of radiologic measurement and decision of fusion level using the angle of pedicle screws inserted for treatment of degenerative lumbar scoliosis.

Materials and Methods

From 2004 to 2008, 74 patients that underwent decompression and posterolateral fusion for degenerative lumbar scoliosis were included in this study. In all cases, instrumentation and posterolateral fusion were both performed. The sex ratio was 31:43, the mean age was 68.7 years and the mean follow up duration was 37.4 months. The angle between each upper end plate of the upper vertebral body and lower end plate of the lower vertebral body of the fusion, and the line parallel to the axis of the sagittal line of vertebrae was each defined as UIV-a and LIV-b. The correlation of development of adjacent segment disease and UIV-a, and LIV-b angle was investigated.

Results

Sum of the absolute value of UIV-a and LIV-b had a statistically significant positive correlation with that of adjacent segment disease. Also, UIV-a alone, had a statistically positive correlation with the development of proximal adjacent segment disease.

Conclusions

Since it is proven that adjacent segment disease has positive correlation with the sum of the absolute value of UIV-a and LIV-b, the extent of fusion should be adjusted to make the line parallel to the line perpendicular to the sagittal surface.

Keywords: Degenerative lumbar scoliosis, Posterolateral fusion, Fusion level, Adjacent segment disease

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Fig. 1.

UIV-a and UIV-b are defined angles formed by 2 lines of the 1st line along the upper end plate of the most upper instrumented vertebra or the lower end plate of the most lower instrumented vertebra and the 2nd sagittal vertical axis of the vertebrae respectively.

Fig. 2.

67-year-old patient with degenerative lumbar scoliosis and stenosis (A) Preoperative radiographs (B) Postoperative radiographs after decompression and posterolateral fusion on L3-S1. UIV-a was 15.2 degrees and LIV-b was 17.9 degrees in this radiographs (C) Last Follow-up radiographs 27 months after the surgery show degenerative changes and development of proximal adjacent segment disease (disc space narrow and sclerosis) at the L2-3 level.

Table 1.

Baseline Demographic findings of patients Baseline patient de-mographics in this study.

No. of patients	74
Age(year)	62.3 (59-74)
Male : Female ratio	30 : 44
F/U duration(month)	37.4 (24-49)
Level of fusion
T12-L4	17
L1-L5	18
L2-L5	24
L2-S1	6
L3-S1	9
Cobb's angle(coronal plane)
Preop	38.5 ± 7.9
Last F/U∗	14.7 ± 6.6
Correction	23.8 ± 4.7

^∗ Postop: follow-up X-ray at last follow up after the surgery

Table 2.

Tilt angles of the upper and lower instrumented end vertebra with relation to adjacent segment disease

	ASD^‡ (n=11)	ASD (-)(n=63)	p-value
UIV-a∗	14.5±5	6.7±4
LIV-b^†	16.9±8	12.5±9
\| UIV-a \|+\| LIV-b \|	31.4±11	19.2±7	0.047

^∗ UIV-a: tilt angle of the upper end plate of the upper instrumented vertebra

^† LIV-b: tilt angle of the lower end plate of the lower instrumented vertebra

^‡ ASD: adjacent segment disease

Table 3.

Tilt angles of the upper and lower instrumented end vertebra with relation to proximal or distal adjacent segment disease respectively

	Proximal ASD^‡	Proximal ASD (-)	p-value
No. of patients	7	67
UIV-a∗	15.3±7	7.9±6	0.042
	Distal ASD	Distal ASD (-)	p-value
No. of patients	4	70
LIV-b^†	17.4±7	19.6±8	0.274

^∗ UIV-a: upper instrumented vertebra

^† LIV-b: lower instrumented vertebra

^‡ ASD: adjacent segment disease

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