CHANGES IN RADIOGRAPHIC PARAMETERS AFTER MINIMALLY INVASIVE LUMBAR INTERBODY FUSION

Vialle, Emiliano; Schleifer, David; Carneiro, Abel; Colina, Orlando; Vialle, Luiz Roberto

doi:10.1590/S1808-185120151404152744

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Original Articles • Coluna/Columna 14 (4) • Oct-Dec 2015 • https://doi.org/10.1590/S1808-185120151404152744 copy

CHANGES IN RADIOGRAPHIC PARAMETERS AFTER MINIMALLY INVASIVE LUMBAR INTERBODY FUSION

ALTERAÇÕES DOS PARÂMETROS RADIOGRÁFICOS DEPOIS DE FUSÃO INTERSOMÁTICA LOMBAR MINIMAMENTE INVASIVA

CAMBIOS EN LOS PARÁMETROS RADIOGRÁFICOS EN FUSIÓN LUMBAR INTERSOMÁTICA MÍNIMAMENTE INVASIVA

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

: This study aims to evaluate changes in lumbosacral parameters after minimally invasive lumbar interbody fusion. The secondary aim was to evaluate whether interbody cage shape (crescent shaped or rectangular) would influence the results.

Method

: Retrospective analysis of 70 patients who underwent one or two level lumbar interbody fusion through a minimally invasive posterolateral approach. This included midline preservation and unilateral facetectomy. Pre- and postoperative (three to six months postoperative) radiographs were used for measuring lumbar lordosis (LL), segmental lordosis (SL) at the level of interbody fusion, and sacral slope (SS). Further analyses divided the patients into Roussouly lumbar subgroups.

Results

: LL was significantly reduced after surgery (59^o:39^o, p=0.001) as well as the SS (33.8^o:31.2^o, p=0.05). SL did not change significantly (11.4:11.06, p=0.85). There were no significant differences when comparing patients who received crescent shaped cage (n=27) and rectangular cage (n=43). Hypolordotic patients (Roussouly types 1 and 2) had radiographic improvement in comparison to normolordotic and hyperlordotic groups (types 3 and 4).

Conclusion

: Minimally invasive lumbar interbody fusion caused reduction in lumbosacral parameters. Cage shape had no influence on the results.

Lumbosacral region; Spine; Spondylosis; Spinal fusion; Postural balance; Minimally invasive surgical procedures

Lordosis	N	F	M	Mean age
1	12	3	9	45
2	17	7	10	43.3
3	35	18	17	43
4	6	4	2	40.6
Total	70

Lordosis type	SLPre-	SLpost-	p	LL Pre-	LLPost-	P	SSPre-	SS post-	P
1	11.58	11.16	0.42	44.90	38.85	0.09	29.25	26.58	0.09
2	11.23	11.52	0.44	37	35.75	0.36	24.47	28.52	0.05
3	11.94	11	0.29	56.05	44.96	<0.001	39.94	33.48	0.0001
4	11.75	13.66	0.27	64.2	57.16	0.16	42.8	37.16	0.23

Author	Year	Open X MIS	Cage shape	SL
Yson¹¹	2012	open	BSC	+7.2
Jagannathan⁷7. Jagannathan J, Sansur CA, Oskouian RJ, Fu KM, Shaffrey CI. Radiographic restoration of lumbar alignment after transforaminal lumbar interbody fusion. Neurosurgery. 2009;64:955-64.	2009	open	BSC	+17.4
Liang¹³13. Liang Y, Shi W, Jiang C, Chen Z, Liu F, Feng Z, Jiang X. Clinical outcomes and sagittal alignment of single-level unilateral instrumented transforaminal lumbar interbody fusion with a 4 to 5-year follow-up. Eur Spine J. 2015;Apr 14 .	2015	MI	BSC	+0.9
Godde¹1. Gödde S, Fritsch E, Dienst M, Kohn D. Influence of cage geometry on sagittal alignment in instrumented posterior lumbar interbody fusion. Spine 2003;28:1693-9.	2003	Open	BSC vs RSC	Favors BSC
Lee²2. Lee KH, Yue WM, Yeo W, Soeharno H, Tan SB. Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J. 2012;21:2265-70.	2012	Open vs MI	BSC	NRM
Sakaura³3. Sakaura H, Yamashita T, Miwa T, Ohzono K, Ohwada T. Symptomatic adjacent segment pathology after posterior lumbar interbody fusion for adult low-grade isthmic spondylolisthesis. Glob Spine J. 2013;3:219-24.	2013	Open	RSC	NRM
Hey⁶6. Hey HWD, Hee HT. Open and minimally invasive transforaminal lumbar interbody fusion: comparison of intermediate results and complications. Asian Spine J. 2015;9:185-93.	2015	Open vs MI	BSC	Cage was shorter in MI
Sidhu⁸8. Sidhu GS, Henkelman E, Vaccaro AR, Albert TJ, Hilibrand A, Anderson DG, et al. Minimally invasive versus open posterior lumbar interbody fusion: a systematic review. Clin Orthop Relat Res. 2014;472: 1792-9.	2014	Open vs MI	RSC	NRM
Takahashi⁹9. Takahashi H, Suguro T, Yokoyama Y, Iida Y, Terashima F, Wada A. Effect of cage geometry on sagittal alignment after posterior lumbar interbody fusion for degenerative disc disease. J Orthop Surg. 2010;18:139-42.	2010	Open	RSC
Villavicencio¹⁰10. Villavicencio AT, Burneikiene S, Roeca CM, Nelson EL, Mason A. Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int. 2010;1:12.	2010	Open vs MI	BSC	NRM
Fujimori¹²12. Fujimori T, Le H, Schairer WW, Berven SH, Oamirani E, Hu SS. Does Transforaminal lumbar interbody fusion have advantages over posterolateral lumbar fusion for degenerative spondylolisthesis? Global Spine J. 2015; 5(2):102-9.	2015	Open	BSC	NRM
Kim JT¹⁴. Kim JT, Shin MH, Lee HJ, Choi DY. Restoration of lumbopelvic sagittal alignment and its maintenance following. Eur Spine J. 2015;Mar 25.	2015	Open	BSC vs RSC	5.48vs3.37

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[1] Correspondence: Rua Brigadeiro Franco 979, Curitiba, Brazil. 80430-210. evialle@hotmail.com

	SL pre	SL post	p	LL pre	LL post	p
All patients	11.4	11.06	0.85	59	39	0.001
BSC	12.1	10.7	0.2	49.5	41.7	0.01
RSC	11.3	11.8	0.3	50.4	43.7	0.009
	SS pre	SS post	p
All patients	33.8	31.2	0.05
BSC	33.9	29.8	0.04
RSC	34.8	32.3	0.1

	LS pre-	LS post-	p	LL pre-	LL post-	P
Female	12.7	12.2	0.4	52.5	43.2	0.003
Male	11	10	0.4	48.3	42.7	0.02
	SS pre	SS post-	P
Female	36.2	33.1	0.08
Male	33.2	29.8	0.05