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Anterior lumbar interbody fusions combined with posterior column osteotomy in patients who had sagittal imbalance associated with degenerative lumbar flat-back deformity: a retrospective case series

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Abstract

Anterior lumbar interbody fusion (ALIF) combined with posterior column osteotomy (PCO) may be effective to achieve ideal lumbar curve correction in lumbar flat-back deformity (LFD). We aimed to investigate the radiographic and clinical outcomes of patients with primary degenerative LFD treated with multi-level ALIFs combined with PCOs. Seventy patients with primary degenerative LFD who underwent corrective surgery were divided into three groups according to the 1-month postoperative pelvic incidence/lumbar lordosis (PI-LL) angles (≤ − 10°, from − 9° to 9°, and ≥ 10°). The spinopelvic parameters, including thoracic kyphosis, LL, pelvic tilt, T1 pelvic angle, and sagittal vertical axis, were analyzed at the preoperative, postoperative follow-up periods. The clinical outcomes, including the Oswestry disability index (ODI), visual analog scale (VAS), and Scoliosis Research Society (SRS)-22r, were also evaluated. Further, the paraspinal muscles were qualitatively and quantitatively examined, preoperatively. All spinopelvic parameters were corrected as close to the normal values at the 1-month postoperative period. The spinopelvic parameters in the PI-LL ≤ − 10° group were better corrected and maintained than those in the other groups. The ODI, VAS, and SRS-22r scores improved at the final follow-up in all groups. The PI-LL ≤ − 10° group showed better clinical outcomes than the other groups. In the paraspinal muscle examination, the mean lumbar muscularity value and fatty degeneration ratio were 236.7% and 20.7%, respectively. Multi-level ALIFs with PCOs in patients with LFD are effective in restoring sagittal balance and improving clinical symptoms. In addition, the postoperative LL angles should be larger than PI + 10° to achieve good overall outcomes in patients with severe degenerative back muscle.

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Funding

This work was supported by research grants from Daegu Catholic University in 2018 IRB approval: KMC IRB 2016-01-207.

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Authors and Affiliations

  1. Department of Neurosurgery, Daegu Catholic University Medical Center, Daegu Catholic University College of Medicine, Daegu, South Korea

    Man Kyu Choi

  2. Department of Neurosurgery, Barun Spine & Joint Hospital, 145, Yeouidaebang-ro, Yeongdeungpo-gu, Seoul, 07392, South Korea

    Sung Min Kim

  3. Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University, School of Medicine, Seoul, South Korea

    Dae Jean Jo

Authors
  1. Man Kyu Choi
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  2. Sung Min Kim
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  3. Dae Jean Jo
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Correspondence to Sung Min Kim.

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The first author (MK Choi) has received research grants from Catholic University of Daegu. The other authors (SM Kim and DJ Jo) declare that they have no conflict of interest.

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The study was approved by the institutional review board (KMC 2016-01-207).

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Informed consent was obtained from all individual participants included in the study.

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Choi, M.K., Kim, S.M. & Jo, D.J. Anterior lumbar interbody fusions combined with posterior column osteotomy in patients who had sagittal imbalance associated with degenerative lumbar flat-back deformity: a retrospective case series. Neurosurg Rev 43, 1117–1125 (2020). https://doi.org/10.1007/s10143-019-01129-w

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  • DOI: https://doi.org/10.1007/s10143-019-01129-w

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