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Restoring spinopelvic harmony with lateral lumbar interbody fusion: Is it a realistic goal?

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Asaid, M, Cox, A, Breslin, M ORCID: 0000-0002-8135-3136, Siedler, D, Sutterlin, C and Dubey, A 2020 , 'Restoring spinopelvic harmony with lateral lumbar interbody fusion: Is it a realistic goal?' , Journal of Spine Surgery, vol. 6, no. 4 , pp. 639-649 , doi: 10.21037/jss-20-605.

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Abstract

Background: The importance of spinopelvic harmony [pelvic incidence (PI) = lumbar lordosis (LL) ±10 degrees] is well established in the literature. We aimed to determine whether lateral lumbar interbody fusion (LLIF) surgery in isolation is successful in restoring spinopelvic harmony, and whether the surgery maintained the relationship in those who present in a balanced state.Methods: A retrospective radiographic analysis was performed on patients who underwent LLIF surgery, followed by posterior instrumented fusion, between January 2012 to August 2019 by a single surgeon (AD). Pre- and post-operative X-rays were reviewed by two authors using Surgimap spinal imaging 2.2.15.5. The LL, PI, and PI-LL mismatch, as well as a range of coronal and segmental sagittal radiographic parameters, were recorded.Results: A total of 71 patients with 170 levels treated via LLIF were analysed. A mean pre-operative PI-LL of 14.3 degrees and post-operative value of 13.4 degrees was recorded (P=0.43). Of the 41 patients who were imbalanced pre-operatively, 13 (31.7%) were restored to a LL within 10 degrees of PI post-LLIF procedure. 30 patients presented in spinopelvic harmony, and 25 (83.3%) of those maintained that relationship following LLIF. Mean coronal global Cobb angles (13.7 degrees pre-operatively to 7.7 degrees post-operatively), segmental coronal Cobb angles (3.8 to 0.9 degrees), and anterior (5.2 to 9.8 mm) and posterior (3.2 to 6.7 mm) disc heights all improved significantly post-LLIF surgery (PConclusions: Although an effective treatment for coronal deformities and providing indirect decompression for degenerative lumbar disc disease, LLIF surgery alone is unlikely to result in correction of sagittal deformity and in particular spinopelvic harmony.

Item Type: Article
Authors/Creators:Asaid, M and Cox, A and Breslin, M and Siedler, D and Sutterlin, C and Dubey, A
Keywords: spinal fusion, lordosis, lumbar vertebrae
Journal or Publication Title: Journal of Spine Surgery
Publisher: AME Publishing Company
ISSN: 2414-469X
DOI / ID Number: 10.21037/jss-20-605
Copyright Information:

© 2020 Journal of Spine Surgery. This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/

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