World neurosurgery · 2023
Risk Factors for the Aggravation of Sagittal Balance After L5-S1 Posterior Lumbar Interbody Fusion.
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Lee Hyung Rae, Cho Jae Hwan, Lee Dong-Ho, Seok Sang Yun, Hwang Chang Ju, Lee Choon Sung
Аннотация
OBJECTIVE: To identify the risk factors for the aggravation of sagittal alignment after single-level L5-S1 PLIF.
METHODS: Eighty-six patients who underwent L5-S1 PLIF were divided into 2 groups according to the postoperative changes in the segmental angle (SA; group I: increase; group D: decrease). The 2 groups were compared in terms of demographic, clinical, and radiological outcomes. Multivariate logistic regression analysis was performed to identify the risk factors for aggravation of sagittal alignment.
RESULTS: Of the study patients, 39 (45%) were categorized as group I and 47 (55%) as group D. The demographic and clinical parameters were not significantly different between the 2 groups. Group D showed postoperative deteriorations in the local sagittal parameters, including lumbar lordosis (LL; P = 0.034), sacral slope (P = 0.012), and pelvic tilt (P = 0.003). In contrast, group I showed improved LL after surgery (P = 0.021). Large preoperative values of lumbosacral angle (LSA; odds ratio [OR], 1.287; P = 0.001), SA (OR, 1.448; P < 0.001), and flexion LSA (OR, 1.173; P = 0.011) were independent risk factors for the aggravation of sagittal balance.
CONCLUSIONS: Surgeons treating patients with large preoperative SA, LSA, and flexion LSA at L5-S1 level should be cautious of the possible aggravation of sagittal balance after L5-S1 PLIF and may consider different surgical approaches such as anterior or oblique lumbar interbody fusion.
METHODS: Eighty-six patients who underwent L5-S1 PLIF were divided into 2 groups according to the postoperative changes in the segmental angle (SA; group I: increase; group D: decrease). The 2 groups were compared in terms of demographic, clinical, and radiological outcomes. Multivariate logistic regression analysis was performed to identify the risk factors for aggravation of sagittal alignment.
RESULTS: Of the study patients, 39 (45%) were categorized as group I and 47 (55%) as group D. The demographic and clinical parameters were not significantly different between the 2 groups. Group D showed postoperative deteriorations in the local sagittal parameters, including lumbar lordosis (LL; P = 0.034), sacral slope (P = 0.012), and pelvic tilt (P = 0.003). In contrast, group I showed improved LL after surgery (P = 0.021). Large preoperative values of lumbosacral angle (LSA; odds ratio [OR], 1.287; P = 0.001), SA (OR, 1.448; P < 0.001), and flexion LSA (OR, 1.173; P = 0.011) were independent risk factors for the aggravation of sagittal balance.
CONCLUSIONS: Surgeons treating patients with large preoperative SA, LSA, and flexion LSA at L5-S1 level should be cautious of the possible aggravation of sagittal balance after L5-S1 PLIF and may consider different surgical approaches such as anterior or oblique lumbar interbody fusion.