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KMID : 0388720150220040170
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Journal of Korean Society of Spine Surgery
2015 Volume.22 No. 4 p.170 ~ p.177
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Restoration of Segmental Lordosis and Related Factors in Interbody Fusion for Degenerative Lumbar Disease
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:Kim Eung-Ha
:Seo Jung-Moo/:Ahn Joong-Hyeon
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Abstract
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Study Design : A retrospective study.
Objectives : To analyze restoration of segmental lordosis and factors related to interbody fusion and the fusion rate with degenerative lumbar disease.
Summary of Literature Review : Few studies have addressed the restoration of segmental lordosis and factors related to interbody fusion for degenerative lumbar disease.
Materials and Methods : Records of 43 patients treated by anterior lumbar interbody fusion (ALIF) or posterior lumbar interbody fusion (PLIF) surgery from 2011 to 2013 were reviewed. ALIF used a metal cage with a 10° lordotic angle and PLIF used a metal cage with an 8° lordotic angle. Preoperative, postoperative, and at least 1 year outcomes were analyzed from radiographs. As a related factor, segmental flexibility, disc height, osteophytes, vaccuum disc, hypertrophic facet, spondylolisthesis, and endplate violation were analyzed. We also analyzed the bony union rate.
Results : The segmental lordotic angle was 4.67° before surgery, improved to 10.43° after surgery, and was 9.32° at the final follow-up. Comparing between the ALIF and PLIF at the L3-4 level in a similar number of patients revealed 7.24° and 4.61° restoration after ALIF and PLIF surgery, postoperatively. The difference was statistically significant (p=0.011). Segmental flexibility had a statistically significant positive correlation (p=0.013). Lower disc height and osteophytes limited restoration of segmental lordosis, but vaccuum disc was restored well after interbody fusion. Bony union was achieved in 92.8% of the cases.
Conclusions : Intebody fusion, especially ALIF surgery, results in acceptable restoration of segmental lordosis. Even with narrowed disc space or osteophytes, remained segmental flexibility is an important factor of segmental lordosis restoration.
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KEYWORD
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Degenerative lumbar disease, Interbody fusion, Segmental lordosis, Segmental flexibility, Fusion rate
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