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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(03): e210-e219
DOI: 10.1055/s-0042-1758209
Original Article

Spinopelvic Parameters in the Clinical and Functional Outcomes of Patients Submitted to Lumbar Interbody Fusion Surgery – A Prospective Study

Parâmetros espinopélvicos nos resultados clínicos e funcionais de pacientes submetidos a fusão intersomática lombar: um estudo prospectivo
Renata Marques 
1   Department of Neurosurgery, Hospital de Braga, Braga, Portugal
,
Ana Cristina Silva 
2   School of Medicine, Life and Health Sciences Research Institute (ICVS), University of Minho, Braga, Portugal
3   Laboratório Associado, Instituto de Investigação em Ciências da Vida e Saúde (ICVS), Braga/Guimarães, Portugal
,
João Nogueira 
1   Department of Neurosurgery, Hospital de Braga, Braga, Portugal
,
Miguel Afonso 
1   Department of Neurosurgery, Hospital de Braga, Braga, Portugal
,
Nubélio Duarte 
1   Department of Neurosurgery, Hospital de Braga, Braga, Portugal
› Author Affiliations Funding The authors declare they have not received funding pertaining to the present study.
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Abstract

Objectives The relevance of spinopelvic parameters in the patients' clinical and functional outcomes has been widely studied in long spinal fusion. Yet, the importance of the spinopelvic parameters in short-segment fusion surgeries needs further investigation. We analyzed the spinopelvic parameters and surgical outcomes of patients undergoing short-segment lumbar interbody fusion.

Materials and Methods An observational, prospective study was conducted between January and June 2021. We selected 25 patients with lumbar stenosis, with or without concomitant spondylolisthesis, undergoing transforaminal lumbar interbody fusion. Variables related to the patient, diagnosis, and surgery were collected. The clinical and functional outcomes were assessed using the Visual Analogue Scale for low-back and leg pain and the Oswestry Disability Index (ODI). The surgical outcomes and spinopelvic parameters were analyzed pre- and postoperatively.

Results There was a significant clinical and functional improvement after surgery (p < 0.001), with a mean ODI decrease of 63.6%. The variables of obesity, concomitant spondylolisthesis, absence of osteotomy, and two-level fusion were all associated with lower levels of improvement after surgery (p < 0.05). Pelvic incidence minus lumbar lordosis (PI-LL) was the only parameter that significantly changed regarding the pre- and postoperative periods (p < 0.05). Before surgery, PI-LL < −10° correlates with less low-back pain after surgery (r = 0.435; p < 0.05). Postoperatively, no correlation was found between surgical outcomes and all the spinopelvic parameters analyzed.

Conclusions The clinical and functional outcomes significantly improved with the surgical intervention but did not correlate with the change in spinopelvic parameters. Patients with preoperative PI-LL < −10° seem to benefit the most from surgery, showing greater improvement in back pain.

Resumo

Objetivos A influência dos parâmetros espinopélvicos nos resultados clínicos e funcionais dos pacientes tem sido amplamente estudada nas cirurgias de fusão espinhal que envolvem longos segmentos. Contudo, a literatura é escassa acerca da fusão de segmentos curtos. Analisamos assim os parâmetros espinopélvicos e os resultados cirúrgicos de pacientes submetidos a fusão intersomática lombar de segmentos curtos.

Materiais e Métodos Realizou-se um estudo prospectivo observacional entre janeiro e junho de 2021. Selecionaram-se 25 pacientes com estenose lombar, com ou sem espondilolistese, submetidos a fusão intersomática lombar transforaminal. Colheram-se dados relacionados com o paciente, o diagnóstico e a cirurgia. Os resultados clínicos e funcionais foram avaliados por meio da Escala Visual Analógica para dor lombar e dos membros inferiores e pela Escala de Incapacidade de Oswestry (Oswestry Disability Index, ODI, em inglês). Os resultados cirúrgicos e os parâmetros espinopélvicos foram analisadas no pré e no pós-operatório.

Resultados Verificou-se uma melhoria clínica e funcional significativa após a cirurgia (p < 0,001), com redução média do ODI de 63,6%. As variáveis obesidade, espondilolistese concomitante, ausência de osteotomia e fusão de dois níveis associaram-se a menor melhoria no pós-operatório (p < 0,05). O único parâmetro que mudou significativamente antes e após a cirurgia (p < 0,05) foi a incidência pélvica menos a lordose lombar (IP-LL). No pré-operatório, uma IP-LL < −10° correlacionou-se com menos dor lombar após a cirurgia (r = 0,435; p < 0,05). No pós-operatório, não houve correlação entre os resultados clínicos e funcionais e os parâmetros espinopélvicos.

Conclusão Os resultados clínicos e funcionais melhoraram significativamente após a cirurgia, mas não se correlacionam com a mudança dos parâmetros espinopélvicos. Pacientes com IP-LL< −10° no pré-operatório apresentam maior melhoria da dor lombar no pós-operatório.

Keywords

spinopelvic parameters - Oswestry disability index - transforaminal lumbar interbody fusion

Palavras-chave

parâmetros espinopélvicos - escala de incapacidade de Oswestry - fusão intersomática lombar transforaminal

Data Availability

The authors declare that all relevant data supporting the findings of the present study are either provided in the Article and Supplementary files or available from the authors upon request.


Renata Marques and Ana Cristina Silva contributed equally to the present work.


Supplementary Material



Publication History

Received: 03 March 2022

Accepted: 12 July 2022

Article published online:
29 September 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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