Journal List > J Korean Soc Spine Surg > v.20(2) > 1076011

J Korean Soc Spine Surg. 2013 Jun;20(2):51-57. Korean.
Published online June 30, 2013.  https://doi.org/10.4184/jkss.2013.20.2.51
© Copyright 2013 Korean Society of Spine Surgery
Restoration of Lumbar Lordosis After Posterior Lumbar Interbody Fusion with 4 Degree Cage in Degenerative Spinal Disease
Kyu-Jung Cho, M.D., Young-Tae Kim, M.D., Seung-Rim Park, M.D. and Seung-Hyun Hong, M.D.
Department of Orthopedic Surgery, School of Medicine, Inha University, Incheon, Korea.

Corresponding author: Kyu-Jung Cho, M.D. Department of Orthopedic Surgery, Inha University Hospital 7-206, 3rd Street Sinheung-Dong, Jung-Gu, Incheon, 400-103, Korea. TEL: 82-32-890-3043, FAX: 82-32-890-3047, Email: chokj@inha.ac.kr
Received April 23, 2012; Revised July 04, 2012; Accepted February 25, 2013.

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 radiological evaluation.

Objectives

This purpose of this study is to determine how much lumbar lordosis and disc heights are restored after posterior lumbar interbody fusion (PLIF) with cage in degenerative spinal disease.

Summary of Literature Review

Restoration of lumbar lordosis in lumbar spine surgery is crucial for clinical outcomes, but there are few studies about the relationship between restoration of lumbar lordosis and cage.

Material and Method

Eighty-one patients with degenerative spinal diseases underwent PLIF using metal cage with 4° lordotic angle. The mean age was 61 year-old (range 38-83 years). Cases with late complications including nonunion, subsidence of cage and instrument failure were excluded in this study. Lumbar lordosis, segmental lordosis, disc height, and sagittal alignment were analyzed on radiographs.

Results

The fused level was one segment in 62 patients and two segments in 19 patients. All patients had the fusion from L3 to the sacrum. Preoperative lumbar lordosis was 34.2°, improved to 34.6° after surgery, and then changed to 32.2° at the final follow-up, demonstrating that the cage with 4° lordotic angle was not effective to restore lumbar lordosis. Segmental lordosis at the level of cage decreased at the final follow-up as compared to preoperative value at all segments. Disc height was improved at the final follow-up as compared to preoperative value.

Conclusion

Disc height was restored after PLIF using cage in the surgery for degenerative lumbar spine. However, lumbar lordosis and segmental lordosis were decreased at the final follow-up as compared to preoperative lordosis.

Keywords: Posterior lumbar interbody fusion; Cage; Lumbar Lordosis; Segmental Lordosis; Disc Height

Figures


Fig. 1
Measurement method of disc height. The midpoint between the 2 posterior corners and the midpoints between the 2 anterior corners were computed. A bisectrix of the sagittal plane angle between the vertebra's midplane was computed and the perpendicular distances to the upper vertebra's lower anterior corner and the lower vertebra's upper anterior corner determined.

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Fig. 2
Loss of lumbar lordosis after posterior lumbar interbody fusion for the patient with spinal stenosis. (A) On preoperative x-ray lumbar lordosis was 32.7° and segmental lordosis at L45 was 7.4°. (B) At the final follow-up, lumbar lordosis was 25.3° and segmental lordosis was 4.3° with significant loss of lordosis.
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Tables


Table 1
Change of lumbar lordosis
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Table 2
Change of segmental lordosis
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Table 3
Change of disc height
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