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

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.

Publikationsverlauf

Eingereicht: 03. März 2022

Angenommen: 12. Juli 2022

Artikel online veröffentlicht:
29. September 2023

• References

• 1 Le Huec JC, Aunoble S, Philippe L, Nicolas P. Pelvic parameters: origin and significance. Eur Spine J 2011; 20 (Suppl. 05) 564-571
• 2 Roussouly P, Nnadi C. Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 2010; 19 (11) 1824-1836
• 3 Mehta VA, Amin A, Omeis I, Gokaslan ZL, Gottfried ON. Implications of spinopelvic alignment for the spine surgeon. Neurosurgery 2012; 70 (03) 707-721
• 4 Alqroom R. The quest of sagittal balance parameters and clinical outcome after short segment spinal fusion. Acta Inform Med 2018; 26 (01) 57-61
• 5 Diebo BG, Varghese JJ, Lafage R, Schwab FJ, Lafage V. Sagittal alignment of the spine: What do you need to know?. Clin Neurol Neurosurg 2015; 139: 295-301
• 6 Duval-Beaupère G, Schmidt C, Cosson P. A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng 1992; 20 (04) 451-462
• 7 Gottfried ON, Daubs MD, Patel AA, Dailey AT, Brodke DS. Spinopelvic parameters in postfusion flatback deformity patients. Spine J 2009; 9 (08) 639-647
• 8 Schwab F, Patel A, Ungar B, Farcy JP, Lafage V. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 2010; 35 (25) 2224-2231
• 9 Le Huec JC, Thompson W, Mohsinaly Y, Barrey C, Faundez A. Sagittal balance of the spine. Eur Spine J 2019; 28 (09) 1889-1905
• 10 Amabile C, Le Huec JC, Skalli W. Invariance of head-pelvis alignment and compensatory mechanisms for asymptomatic adults older than 49 years. Eur Spine J 2018; 27 (02) 458-466
• 11 Oikonomidis S, Heck V, Bantle S. et al. Impact of lordotic cages in the restoration of spinopelvic parameters after dorsal lumbar interbody fusion: a retrospective case control study. Int Orthop 2020; 44 (12) 2665-2672
• 12 Lazennec J-Y, Ramaré S, Arafati N. et al. Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 2000; 9 (01) 47-55
• 13 Makino T, Kaito T, Fujiwara H. et al. Risk Factors for Poor Patient-Reported Quality of Life Outcomes After Posterior Lumbar Interbody Fusion: An Analysis of 2-Year Follow-up. Spine 2017; 42 (19) 1502-1510
• 14 Haefeli M, Elfering A. Pain assessment. Eur Spine J 2006; 15 (Suppl. 01) S17-S24
• 15 Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25 (22) 2940-2952 , discussion 2952
• 16 Morvan G, Mathieu P, Vuillemin V. et al. Standardized way for imaging of the sagittal spinal balance. Eur Spine J 2011; 20 (Suppl. 05) 602-608
• 17 Farrokhi MR, Eghbal K, Mousavi SR, Moumani M, Bazyari K. chaurasia B. Comparative Study between Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion for Treatment of Spondylolisthesis: Clinical Outcomes and Spino-Pelvic Sagittal Balance Parameters. Indian Journal of Neurotrauma 2021; 18 (01) 51-58
• 18 De la Garza-Ramos R, Bydon M, Abt NB. et al. The impact of obesity on short- and long-term outcomes after lumbar fusion. Spine 2015; 40 (01) 56-61
• 19 Chan AK, Bisson EF, Bydon M. et al. Obese Patients Benefit, but do not Fare as Well as Nonobese Patients, Following Lumbar Spondylolisthesis Surgery: An Analysis of the Quality Outcomes Database. Neurosurgery 2020; 86 (01) 80-87
• 20 Duan PG, Mummaneni PV, Wang M. et al. Obesity may be associated with adjacent-segment degeneration after single-level transforaminal lumbar interbody fusion in spinopelvic-mismatched patients with a minimum 2-year follow-up. J Neurosurg Spine 2020; 34 (01) 1-6
• 21 Försth P, Ólafsson G, Carlsson T. et al. A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis. N Engl J Med 2016; 374 (15) 1413-1423
• 22 Sakaura H, Yamashita T, Miwa T, Ohzono K, Ohwada T. Outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis. J Neurosurg Spine 2013; 19 (01) 90-94
• 23 Aoki Y, Nakajima A, Takahashi H. et al. Influence of pelvic incidence-lumbar lordosis mismatch on surgical outcomes of short-segment transforaminal lumbar interbody fusion. BMC Musculoskelet Disord 2015; 16 (01) 213-219
• 24 He S, Zhang Y, Ji W. et al. Analysis of spinopelvic sagittal balance and persistent low back pain (PLBP) for degenerative spondylolisthesis (DS) following posterior lumbar interbody fusion (PLIF). Pain Res Manag 2020; 2020: 5971937
• 25 Senteler M, Weisse B, Snedeker JG, Rothenfluh DA. Pelvic incidence-lumbar lordosis mismatch results in increased segmental joint loads in the unfused and fused lumbar spine. Eur Spine J 2014; 23 (07) 1384-1393
• 26 Inami S, Moridaira H, Takeuchi D, Shiba Y, Nohara Y, Taneichi H. Optimum pelvic incidence minus lumbar lordosis value can be determined by individual pelvic incidence. Eur Spine J 2016; 25 (11) 3638-3643
• 27 Schwab F, Ungar B, Blondel B. et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine 2012; 37 (12) 1077-1082
• 28 Schwab FJ, Blondel B, Bess S. et al; International Spine Study Group (ISSG). Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine 2013; 38 (13) E803-E812
• 29 Zhang HC, Zhang ZF, Wang ZH. et al. Optimal Pelvic Incidence Minus Lumbar Lordosis Mismatch after Long Posterior Instrumentation and Fusion for Adult Degenerative Scoliosis. Orthop Surg 2017; 9 (03) 304-310
• 30 Hioki A, Miyamoto K, Kodama H. et al. Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis. Spine J 2005; 5 (06) 600-607
• 31 Divi SN, Kepler CK, Hilibrand AS. et al. Patient Outcomes Following Short-segment Lumbar Fusion Are Not Affected by PI-LL Mismatch. Clin Spine Surg 2021; 34 (02) 73-77
• 32 Eghbal K, Pourabbas B, Abdollahpour HR, Mousavi R. Clinical, functional, and radiologic outcome of single- and double-level transforaminal lumbar interbody fusion in patients with low-grade spondylolisthesis. Asian J Neurosurg 2019; 14 (01) 181-187
• 33 Matsumoto T, Okuda S, Maeno T. et al. Spinopelvic sagittal imbalance as a risk factor for adjacent-segment disease after single-segment posterior lumbar interbody fusion. J Neurosurg Spine 2017; 26 (04) 435-440
• 34 Rothenfluh DA, Mueller DA, Rothenfluh E, Min K. Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion. Eur Spine J 2015; 24 (06) 1251-1258