Minimally invasive transforaminal lumbar interbody fusion for treatment of single-segment lumbar spinal stenosis improves lumbar-pelvic balance

doi:10.3969/j.issn.2095-4344.4013

Abstract

Abstract: BACKGROUND: More and more studies have shown that lumbar-pelvic parameters are closely related to the clinical effect and adjacent segment degeneration after lumbar fusion, but the effect of minimally invasive transforaminal interbody fusion on lumbar-pelvic parameters is not clear.
OBJECTIVE: To evaluate the effect of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) on the lumbar-pelvic imaging parameters in patients with single-segment lumbar spinal stenosis.
METHODS: The clinical data of 85 patients with single-segment lumbar spinal stenosis treated by MIS-TLIF and open-TLIF in the First Affiliated Hospital of Dali University from January 2015 to January 2017 were retrospectively analyzed, including 39 cases of MIS-TLIF operation (MIS-TLIF group) and 46 cases of open-TLIF operation (open-TLIF group). On the standing lateral lumbar X-ray containing bilateral femoral heads: lumbar lordosis, segmental lordosis, height of the intervertebral disc, the L1 axis and S1 distance, pelvic incidence, pelvic tilt, and sacral slope were measured, and the difference between pelvic incidence−lumbar lordosis and the ratio of lumbar lordosis/pelvic incidence were calculated.
RESULTS AND CONCLUSION: (1) During the last follow-up, lumbar lordosis, height of the intervertebral disc, and sacral slope were increased in both groups compared with preoperative parameters, but pelvic tilt was decreased compared with preoperatively, and the difference was significant (P < 0.05). Lumbar lordosis, segmental lordosis, height of the intervertebral disc, pelvic incidence, pelvic tilt, sacral slope and the L1 axis and S1 distance were not significantly different between the two groups during the last follow-up (P > 0.05). (2) During the last follow-up, lumbar lordosis, segmental lordosis, height of the intervertebral disc, pelvic incidence, pelvic tilt, sacral slope, and the L1 axis and S1 distance were not significantly different compared with preoperative parameters (P > 0.05). (3) The difference between pelvic incidence−lumbar lordosis was significantly decreased at the last follow-up compared with preoperative parameters in the two groups (P < 0.05). The ratio of lumbar lordosis/pelvic incidence was significantly increased at the last follow-up compared with preoperative parameters in the two groups, especially in the open-TLIF group (P < 0.05). However, the difference between pelvic incidence−lumbar lordosis and the ratio of lumbar lordosis/pelvic incidence were not significantly different between the two groups (P > 0.05). (4) Above results indicated that for single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open-TLIF in recovery of lumbar lordosis, intervertebral height, and improving lumbar-pelvic balance.

Key words: lumbar spine, lumbar spinal stenosis, pelvis, minimally invasive, transforaminal lumbar interbody fusion, single segment

CLC Number:

Yao Rubin, Wang Shiyong, Yang Kaishun. Minimally invasive transforaminal lumbar interbody fusion for treatment of single-segment lumbar spinal stenosis improves lumbar-pelvic balance[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1387-1392.

Figures/Tables 6

References

[1] KELLER TS, COLLOCA CJ, HARRISON DE, et al. Influence of spine morphology on intervertebral disc loads and stresses in asymptomatic adults: implications for the ideal spine. Spine J. 2005;5(3):297-309.
[2] WEINSTEIN JN, TOSTESON TD, LURIE JD, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the Spine Patient Outcomes Research Trial. Spine. 2010;35(14): 1329-1338.
[3] KADER DF, WARDLAW D, SMITH FW. Correlation between the MRI changes in the lumbar multifidus muscles and leg pain. Clin Radiol. 2000;55(2):145-149.
[4] KIM CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine. 2010;35(S):281-286.
[5] LURIE J, TOMKINS-LANE C. Management of lumbar spinal stenosis. BMJ. 2016;352:h6234.
[6] FAN S, HU Z, ZHAO F, et al. Multifidus muscle changes and clinical effects of one-level posterior lumbar interbody fusion: minimally invasive procedure versus conventional open approach . Eur Spine J. 2009;19(2):316-324.
[7] CHANG HS. Influence of lumbar lordosis on the outcome of decompression surgery for lumbar canal stenosis. World Neurosurg. 2018;109:e68-e90.
[8] SCHWAB F, DUBEY A, PAGALA M, et al. Adult scoliosis: a health assessment analysis by SF-36. Spine. 2003;28(6):602-606.
[9] LEE CH, CHUNG CK, JANG JS, et al. Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance: a meta-analysis. J Neurosurg Spine. 2017; 27(5): 540-551.
[10] MATSUMOTO T, OKUDA S, MAENO T, et al. Spinopelvic sagittal imbalance as a risk factor for adjacent-segment disease after single-segment posterior lumbar interbody fusion. J Neurosurg Spine. 2017; 26(4):435-440.
[11] KIM MK, LEE SH, KIM ES, et al. The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: a pilot study. BMC Musculoskelet Disord. 2011;12:69.
[12] ENDO K, SUZUKI H, TANAKA H, et al. Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J. 2009;19(3): 435-438.
[13] 汪凌骏,顾勇,冯煜,等.脊柱-骨盆矢状面形态变化与椎间盘摘除及后路椎体间植骨融合的关系[J].中国组织工程研究,2015, 19(29): 4598-4602.
[14] SCHWAB F, LAFAGE V, PATEL A, et al. Sagittal plane considerations and the pelvis in the adult patient. Spine. 2009;34(17):1828-1833.
[15] BOISSIERE L, BOURGHLI A, VITAL J M, et al. The lumbar lordosis index: a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery. Eur Spine J. 2013;22(6): 1339-1345.
[16] UMEHARA S, ZINDRICK MR, PATWARDHAN AG, et al. The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine. 2000;25(13): 1617-1624.
[17] OKUDA S, ODA T, YAMASAKI R, et al. Repeated adjacent-segment degeneration after posterior lumbar interbody fusion. J Neurosurg Spine. 2014;20(5): 538-541.
[18] KIM KH, LEE SH, SHIM CS, et al. Adjacent segment disease after interbody fusion and pedicle screw fixations for isolated L4-L5 spondylolisthesis: a minimum five-year follow-up. Spine. 2010;35(6): 625-634.
[19] KAWAKAMI M, TAMAKI T, ANDO M, et al. Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine. 2002; 27(1): 59-64.