Influence of pelvic incidence-lumbar lordosis mismatch on surgical outcomes of short-segment transforaminal lumbar interbody fusion.
BACKGROUND
The importance of pelvic incidence-lumbar lordosis (PI-LL: PI minus LL) mismatch is emphasized in long-segment fusion for adult spinal deformity; however, there are few studies evaluating the influence of PI-LL on surgical outcomes after short-segment fusion. In this study, we have examined the effects of PI-LL mismatch on surgical outcomes of short-segment lumbar intervertebral fusion for lumbar degenerative diseases.


METHODS
Patients with lumbar degenerative disease treated by short-segment (1 or 2 levels) transforaminal lumbar interbody fusion were divided into Group A (PI-LL ≤ 10°: n = 22) and Group B (PI-LL ≥ 11°: n = 30). Pre-and post-operative patient symptoms were assessed by the visual analogue scale (VAS: scores 0-100 mm; for LBP, lower-extremity pain, and lower-extremity numbness), a detailed VAS for LBP while in motion, standing, and sitting, and the Oswestry disability index (ODI). Surgical outcomes were evaluated by the Nakai score (3 = excellent to 0 = poor. Post-operative data were acquired for at least one year following surgery and were compared between the two groups. Multiple regression analyses were used to evaluate the relative influence of PI-LL on each pre-and post-operative parameter (VAS, detailed VAS and ODI) adjusted for age, sex, fusion levels, body mass index, presence of scoliosis, diabetes mellitus and depression.


RESULTS
The surgical outcomes in Group A were significantly better than those of Group B. Group A showed better post-operative VAS scores for LBP, particularly LBP while standing (11.9 vs. 25.8). The results of the multivariate analyses showed no significant correlation between PI-LL and pre-operative symptoms, but did show a significant correlation between PI-LL and the post-operative VAS score for LBP, lower extremity pain, and numbness.


CONCLUSIONS
This study is the first to find that PI-LL mismatch influences post-operative residual symptoms, such as LBP, lower extremity pain and numbness. Among the three types of LBP examined in the detailed VAS, LBP while standing was most strongly related to PI-LL mismatch. The importance of maintaining spinopelvic alignment is emphasized, particularly when treating patients with adult spinal deformity using long-segment fusion surgery. However, our results indicate that surgeons should pay attention to sagittal spinopelvic alignment and avoid post-operative PI-LL mismatch even when treating patients with short-segment lumbar interbody fusion.
Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba, 283-8686, Japan. yasuaoki35@fc4.so-net.ne.jp.|Department of General Medical Science, Graduate School of Medicine, Chiba University, 1-8-1 Inohana,Chuo-ku, Chiba city, Chiba, 260-8670, Japan. yasuaoki35@fc4.so-net.ne.jp.
Yasuchika
Y
Aoki
Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan. a-nakaji@sf7.so-net.ne.jp.
Arata
A
Nakajima
Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan. hirochann@syd.odn.ne.jp.
Hiroshi
H
Takahashi
Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan. masato0609@aol.com.
Masato
M
Sonobe
Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan. terajima-fh@d01.itscom.net.
Fumiaki
F
Terajima
Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan. masahi1214@hotmail.com.
Masahiko
M
Saito
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuoku, Chiba city, Chiba, 260-8677, Japan. 19501114@faculty.chiba-u.jp.
Kazuhisa
K
Takahashi
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuoku, Chiba city, Chiba, 260-8677, Japan. sohtori@faculty.chiba-u.jp.
Seiji
S
Ohtori
Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba, 283-8686, Japan. atsuyan1@pa2.so-net.ne.jp.|Department of General Medical Science, Graduate School of Medicine, Chiba University, 1-8-1 Inohana,Chuo-ku, Chiba city, Chiba, 260-8670, Japan. atsuyan1@pa2.so-net.ne.jp.
Atsuya
A
Watanabe
Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba, 283-8686, Japan. oiranakag7620@yahoo.co.jp.|Department of General Medical Science, Graduate School of Medicine, Chiba University, 1-8-1 Inohana,Chuo-ku, Chiba city, Chiba, 260-8670, Japan. oiranakag7620@yahoo.co.jp.
Takayuki
T
Nakajima
Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, Chiba, 283-8686, Japan. surfer-tkz@hotmail.co.jp.|Department of General Medical Science, Graduate School of Medicine, Chiba University, 1-8-1 Inohana,Chuo-ku, Chiba city, Chiba, 260-8670, Japan. surfer-tkz@hotmail.co.jp.
Makoto
M
Takazawa
Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuoku, Chiba city, Chiba, 260-8677, Japan. sorita@chiba-u.jp.
Sumihisa
S
Orita
Department of Orthopaedic Surgery, National Hospital Organization Shimoshizu Hospital, 934-5Shikawatashi, Yotsukaido, Chiba, 284-0003, Japan. yawara_eguchi@yahoo.co.jp.
Yawara
Y
Eguchi
Department of Orthopaedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan. konakag@aol.com.
Koichi
K
Nakagawa
D000328:Adult; D001416:Back Pain / Q000209:etiology; D004185:Disability Evaluation; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D010292:Paresthesia / Q000209:etiology; D010384:Pelvic Bones / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011859:Radiography; D020127:Recovery of Function; D013123:Spinal Fusion / Q000379:methods*; D013131:Spine / Q000000981:diagnostic imaging*; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome