Postoperative Loss of Lumbar Lordosis Affects Clinical Outcomes in Patients with Pseudoarthrosis After Posterior Lumbar Interbody Fusion Using Cortical Bone Trajectory Screw Fixation

Overview

Journal Asian Spine J

Date 2020 Sep 20

PMID 32951404

Citations 3

Authors

Akira Yamagishi

Hironobu Sakaura

Masayoshi Ishii

Atsunori Ohnishi

Tetsuo Ohwada

Affiliations

Soon will be listed here.

Abstract

Study Design: Retrospective cohort study.

Purpose: This study aimed to investigate relationships between clinical outcomes and radiographic parameters in patients with pseudoarthrosis after posterior lumbar interbody fusion (PLIF).

Overview Of Literature: In some patients with pseudoarthrosis after PLIF, clinical symptoms improve following surgery, although pseudoarthrosis can often be one of the complications. However, there are no previous reports describing differences between patients with pseudoarthrosis after PLIF who have obtained better clinical outcomes and those who have not.

Methods: Twenty-seven patients who were diagnosed with pseudoarthrosis after single-level PLIF with cortical bone trajectory screw fixation (CBT-PLIF) were enrolled in this study. They were divided into two groups based on mean improvement of 22 points on the Oswestry Disability Index (ODI) at the 2-year follow-up. Group G consisted of 15 patients who showed improvement on the ODI of ≥22 points, and group P consisted of the residual 12 patients. Radiographic parameters, percentage of slip, lumbar lordosis (LL), segmental lordosis, segmental range of motion, screw loosening, and subsidence were compared between the two groups.

Results: There were no significant differences between the two groups on radiographic parameters except for postoperative changes in LL. Although surgery-induced changes in LL showed no significant difference between the two groups, changes in LL from before surgery to 2-year follow-up and during postoperative 2-year follow-up were significantly better in group G (mean change of LL: +3.5° and +5.1°, respectively) compared to group P (mean change of LL: -4.6° and -0.5°, respectively) (p<0.01 and 0.05, respectively).

Conclusions: Patients with greater improvement in ODI gained LL over the 2-year follow-up, whereas patients with less improvement in ODI lost LL during the 2-year follow-up. These results indicate that there is a significant correlation between clinical outcomes and LL even in patients with pseudoarthrosis after single-level CBT-PLIF.

Citing Articles

Using Lordotic Cages at the L5-S1 Level Does Not Guarantee the Improvement of Sagittal Alignment in Patients Who Underwent Posterior Lumbar Interbody Fusion.

Cho J, Hwang C, Lee D, Lee C Asian Spine J. 2023; 17(3):477-484.

PMID: 36775831 PMC: 10300896. DOI: 10.31616/asj.2022.0228.

Application of the cortical bone trajectory technique in posterior lumbar fixation.

Peng S, Yuan X, Lu W, Yu K World J Clin Cases. 2023; 11(2):255-267.

PMID: 36686364 PMC: 9850973. DOI: 10.12998/wjcc.v11.i2.255.

Successful salvage strategy using anterior retroperitoneal approach in failed posterior lumbar interbody fusion. A retrospective analisys on lumbar lordosis and clinical outcome.

Bassani R, Morselli C, Cirullo A, Querenghi A, Mangiavini L Eur Spine J. 2022; 31(7):1649-1657.

PMID: 35652952 DOI: 10.1007/s00586-022-07247-2.

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