Comparison of lumbar-pelvic sagittal parameters after single-level and double-level posterior lumbar interbody fusion

doi:10.3969/j.issn.2095-4344.2893

Abstract

Abstract:

BACKGROUND: Posterior lumbar intervertebral fusion is a classic surgical procedure for the treatment of degenerative lumbar spondylolisthesis. It has the advantages of improving lumbar lordosis, increasing the height of the intervertebral space, resetting the spondylolisthesis, and improving the quality of life of patients.

OBJECTIVE: To investigate the effect of single-level and double-level posterior lumbar interbody fusion for low-grade degenerative lumbar spondylolisthesis on lumbar-pelvic sagittal parameters, and analyze the influencing factors of lumbar-pelvic sagittal parameters.

METHODS: A retrospective analysis of 68 patients with degenerative lumbar spondylolisthesis treated with single-level or double-level low-grade (I-II degree) posterior lumbar interbody fusion using polyetheretherketone interbody fusion cage from January 2014 to September 2017 was conducted. According to the fusion segment, the patients were divided into single-level group (n=37) and double-level group (n=31). Before and at the last follow-up, X-ray films of lumbar spine with bilateral femoral head standing position were taken to compare the lumbar-pelvic sagittal parameters, the subsidence rate of fusion cage and bone fusion of the two groups.

RESULTS AND CONCLUSION: (1) The patients in both groups successfully completed the operation and were followed up. All patients were followed up for 12-40 months. (2) The vertebral slip indexes in the single-level group and the double-level group were significantly improved compared with those before surgery (P < 0.05), and there was no significant difference in the improvement between the two groups (P > 0.05). (3) Compared with the preoperation, the pelvic tilt angle was significantly reduced (P < 0.05), and the sacral slope was significantly increased (P < 0.05), but the difference between the two groups was not statistically significant (P > 0.05). (4) Compared with the preoperation, the lumbar lordosis, lower lumbar lordosis, and lumbar lordosis distribution index in the two groups were significantly increased (P < 0.05); and the increase value of the double-level group was significantly higher than that of the single-level group (P < 0.05). (5) Compared with preoperation, L₅ incident, L₅ slope, L₁ axis and S₁ distance were significantly reduced (P < 0.05), and the decrease in the double-level group was significantly greater than that of single-level group (P < 0.05). (6) There was no significant difference in the cage subsidence rate between the two groups (P > 0.05). Bone fusion was achieved in all patients at the last follow-up. (7) Low-grade degenerative lumbar spondylolisthesis can improve sagittal balance through posterior lumbar interbody fusion. The sagittal parameters of lumbar spine and pelvis were more significant after double segment fusion.

Key words: bone, degenerative, lumbar, lumbar spondylolisthesis, interbody fusion, bony fusion, polyetheretherketone, pelvis, sagittal position

CLC Number:

Wei Yangyang, Chen Jiacheng, Sun Jun, Wang Qiuan, Yuan Feng. Comparison of lumbar-pelvic sagittal parameters after single-level and double-level posterior lumbar interbody fusion[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(33): 5300-5306.

Figures/Tables 7

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