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A Surgical Option for Multilevel Anterior Lumbar Interbody Fusion with Ponte Osteotomy to Achieve Optimal Lumbar Lordosis and Sagittal Balance

  • Suh, Loo-Ree (Spine Center, Kyung Hee University Hospital at Gangdong) ;
  • Jo, Dae-Jean (Spine Center, Kyung Hee University Hospital at Gangdong) ;
  • Kim, Sung-Min (Spine Center, Kyung Hee University Hospital at Gangdong) ;
  • Lim, Young-Jin (Department of Neurosurgery, Kyung Hee University Hospital)
  • 투고 : 2011.12.31
  • 심사 : 2012.10.04
  • 발행 : 2012.10.28

초록

Objective : To document lumbar lordosis (LL) of the spine and its change during surgeries with the different height but the same angle setting of the anterior cage. Additionally, we attempted to determine if sufficient LL is achieved at different cage heights and to quantify the change in LL during multi-level anterior lumbar interbody fusion (ALIF). Methods : The medical records and radiographs of 42 patients who underwent more than 2 level ALIFs between 2008 and 2009 were retrospectively reviewed. We evaluated 3 parameters seen on lateral whole spine radiographs : LL, pelvic incidence (PI), and sagittal vertical axis (SVA). The mean follow-up time was 28.1 months and the final follow-up radiographs of all patients were reviewed at least 2 years after surgery. Statistical analysis was performed using the paired t-tests. Results : Lumbar lordosis had changed up to 30 degrees immediately and 2 years after surgery (preoperative mean LL, SVA : 22.45 degrees, 112.31 mm; immediate postoperative mean LL, SVA : 54.45 degrees, 37.36 mm; final follow-up mean LL, SVA : 49.56 degrees, 26.95 mm). Our goal of LL is to obtain as much PI as possible, preoperative mean PI value was $55.38{\pm}3.35$. The pre-operative and two year post-surgery follow-up mean of the Japanese Orthopedic Association score were $9.2{\pm}0.6$ and $13.2{\pm}0.6$ (favorable outcome rate : 95%), respectively. In addition, we were able to obtain good clinical outcomes and sagittal balance with a subsidence rate of 22.7%. Conclusion : We were able to achieve sufficient LL, such that it was similar to the PI, utilizing multi-level ALIF with the use of a tall cage with the same angle setting of the cage. We have found out that achieving sufficient lumbar lordosis and sagittal balance require an anterior lumbar cage with high angle and height.

키워드

참고문헌

  1. Bernhardt M, Bridwell KH : Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine (Phila Pa 1976) 14 : 717-721, 1989 https://doi.org/10.1097/00007632-198907000-00012
  2. Brodke DS, Dick JC, Kunz DN, McCabe R, Zdeblick TA : Posterior lumbar interbody fusion. A biomechanical comparison, including a new threaded cage. Spine (Phila Pa 1976) 22 : 26-31, 1997 https://doi.org/10.1097/00007632-199701010-00005
  3. Cheung KM, Zhang YG, Lu DS, Luk KD, Leong JC : Reduction of disc space distraction after anterior lumbar interbody fusion with autologous iliac crest graft. Spine (Phila Pa 1976) 28 : 1385-1389, 2003
  4. Choi JY, Sung KH : Subsidence after anterior lumbar interbody fusion using paired stand-alone rectangular cages. Eur Spine J 15 : 16-22, 2006 https://doi.org/10.1007/s00586-004-0817-y
  5. Chrastil J, Patel AA : Complications associated with posterior and transforaminal lumbar interbody fusion. J Am Acad Orthop Surg 20 : 283- 291, 2012 https://doi.org/10.5435/JAAOS-20-05-283
  6. Dennis S, Watkins R, Landaker S, Dillin W, Springer D : Comparison of disc space heights after anterior lumbar interbody fusion. Spine (Phila Pa 1976) 14 : 876-878, 1989 https://doi.org/10.1097/00007632-198908000-00019
  7. Garg J, Woo K, Hirsch J, Bruffey JD, Dilley RB : Vascular complications of exposure for anterior lumbar interbody fusion. J Vasc Surg 51 : 946- 950; discussion 950, 2010 https://doi.org/10.1016/j.jvs.2009.11.039
  8. Hsieh PC, Koski TR, O'Shaughnessy BA, Sugrue P, Salehi S, Ondra S, et al. : Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion : implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine 7 : 379-386, 2007 https://doi.org/10.3171/SPI-07/10/379
  9. Inamasu J, Guiot BH : Vascular injury and complication in neurosurgical spine surgery. Acta Neurochir (Wien) 148 : 375-387, 2006 https://doi.org/10.1007/s00701-005-0669-1
  10. Inamasu J, Kim DH, Logan L : Three-dimensional computed tomographic anatomy of the abdominal great vessels pertinent to L4-L5 anterior lumbar interbody fusion. Minim Invasive Neurosurg 48 : 127-131, 2005 https://doi.org/10.1055/s-2004-830262
  11. McDonnell MF, Glassman SD, Dimar JR 2nd, Puno RM, Johnson JR : Perioperative complications of anterior procedures on the spine. J Bone Joint Surg Am 78 : 839-847, 1996
  12. Min JH, Jang JS, Lee SH : Comparison of anterior- and posterior-approach instrumented lumbar interbody fusion for spondylolisthesis. J Neurosurg Spine 7 : 21-26, 2007 https://doi.org/10.3171/SPI-07/07/021
  13. Mummaneni PV, Dhall SS, Ondra SL, Mummaneni VP, Berven S : Pedicle subtraction osteotomy. Neurosurgery 63 : 171-176, 2008 https://doi.org/10.1227/01.NEU.0000325680.32776.82
  14. Ondra SL, Marzouk S, Koski T, Silva F, Salehi S : Mathematical calculation of pedicle subtraction osteotomy size to allow precision correction of fixed sagittal deformity. Spine (Phila Pa 1976) 31 : E973-E979, 2006 https://doi.org/10.1097/01.brs.0000247950.02886.e5
  15. Oxland TR, Lund T, Jost B, Cripton P, Lippuner K, Jaeger P, et al. : The relative importance of vertebral bone density and disc degeneration in spinal flexibility and interbody implant performance. An in vitro study. Spine (Phila Pa 1976) 21 : 2558-2569, 1996 https://doi.org/10.1097/00007632-199611150-00005
  16. Pull ter Gunne AF, Cohen DB : Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine (Phila Pa 1976) 34 : 1422-1428, 2009 https://doi.org/10.1097/BRS.0b013e3181a03013
  17. Rose PS, Bridwell KH, Lenke LG, Cronen GA, Mulconrey DS, Buchowski JM, et al. : Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine (Phila Pa 1976) 34 : 785-791, 2009 https://doi.org/10.1097/BRS.0b013e31819d0c86
  18. Sandhu HS, Turner S, Kabo JM, Kanim LE, Liu D, Nourparvar A, et al. : Distractive properties of a threaded interbody fusion device. An in vivo model. Spine (Phila Pa 1976) 21 : 1201-1210, 1996
  19. Schizas C, Foko'o N, Matter M, Romy S, Munting E : Lymphocoele : a rare and little known complication of anterior lumbar surgery. Eur Spine J 18 Suppl 2 : 228-231, 2009
  20. Schwab F, Patel A, Ungar B, Farcy JP, Lafage V : Adult spinal deformitypostoperative standing imbalance : how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976) 35 : 2224-2231, 2010 https://doi.org/10.1097/BRS.0b013e3181ee6bd4
  21. Subach BR, Copay AG, Martin MM, Schuler TC : Anterior lumbar interbody implants : importance of the interdevice distance. Adv Orthop 2011 : 176497, 2011
  22. Suk KS, Kim KT, Lee SH, Kim JM : Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine (Phila Pa 1976) 28 : 2001-2005, 2003 https://doi.org/10.1097/01.BRS.0000083239.06023.78
  23. Tang S, Meng X : Does disc space height of fused segment affect adjacent degeneration in ALIF? A finite element study. Turk Neurosurg 21 : 296-303, 2011
  24. Unruh KP, Camp CL, Zietlow SP, Huddleston PM 3rd : Anatomical variations of the iliolumbar vein with application to the anterior retroperitoneal approach to the lumbar spine : a cadaver study. Clin Anat 21 : 666- 673, 2008 https://doi.org/10.1002/ca.20711
  25. Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P : Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 87 : 260-267, 2005 https://doi.org/10.2106/JBJS.D.02043

피인용 문헌

  1. Sagittal Plane Correction Using the Lateral Transpsoas Approach: A Biomechanical Study on the Effect of Cage Angle and Surgical Technique on Segmental Lordosis vol.41, pp.17, 2016, https://doi.org/10.1097/brs.0000000000001562