- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Ha Son Nguyen
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
DOI:10.4103/2152-7806.167214Copyright: © 2015 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Nguyen HS, Yoganandan N, Maiman D. Lumbopelvic parameters and the extent of lumbar fusion. Surg Neurol Int 13-Oct-2015;6:164
How to cite this URL: Nguyen HS, Yoganandan N, Maiman D. Lumbopelvic parameters and the extent of lumbar fusion. Surg Neurol Int 13-Oct-2015;6:164. Available from: http://surgicalneurologyint.com/surgicalint_articles/lumbopelvic-parameters-and-the-extent-of-lumbar-fusion/
Background:Following lumbar fusion, sacroiliac (SI) joint pain has been regarded as a form of adjacent segment disease. Prior studies suggest increased stress to the SI joint and pelvis with lumbar fusion. Limited studies have evaluated the relationship between the extent of lumbar fusion and its potential influence on lumbopelvic parameters, which may provide the insights to persistent back pain.
Methods:Three hundred fifty-five patients underwent lumbar fusions at our institution between fall 2010 and winter 2012; 80 patients met criteria for the study. Inclusion criteria included appropriate imaging available (preoperative and postoperative lateral films), follow-up >1-year, fusion where the rostral extent was up to L1 and the caudal extent was at most S1. Exclusion criteria included prior lumbar fusion, history of SI joint syndrome, follow-up
Results:There were no statistically significant differences between pre- and post-operative lumbopelvic parameters within each fusion group.
Conclusion:The results imply that the extent of instrumentation, including the involvement of the sacrum, may not alter lumbopelvic parameters. This appears to argue against the idea that longer fusion constructs induce more stress on the pelvis and SI joint.
Keywords: Lumbar fusion, lumbopelvic parameters, sacropelvic parameters
Lumbopelvic parameters have been employed to evaluate the sagittal alignment after lumbar fusion with respect to sacroiliac (SI) joint pain.[
MATERIALS AND METHODS
The approval of the institutional board review at our hospital was obtained prior to the study.
Between fall 2010 and winter 2012, 355 patients underwent lumbar fusions at our institution. Six spine surgeons performed the surgeries. The study's inclusion and exclusion criteria are outlined in
The clinical data (age, sex, diagnosis, levels of fusion, and extent of follow-up) were collected via chart review. Pre- and post-operative lateral X-rays were evaluated for lumbopelvic parameters using a picture archiving and communication system. The lumbopelvic parameters, which included lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS), were assessed as previously reported.[
For each lumbopelvic parameter, the lumbar fusion groups were compared via one-way ANOVA. If a significant finding (P < 0.05) was discovered, post-hoc testing ensued, where each lumbar fusion group was compared with each other group through all permutations via the Student's t-test to discover the significance found by ANOVA. To compare the preoperative value to the postoperative value of a lumbopelvic parameter, the Student's t-test was also utilized, where P < 0.05 was considered as significant.
Postfusion lower back pain may be caused by SI joint dysfunction or pseudoarthrosis. In particular, SI joint involvement ranges up to 40%.[
Given the potential for SI joint dysfunction after lumbar fusion, SI joint pain has been evaluated in the context of lumbopelvic sagittal alignment in prior studies. Briefly, the lumbopelvic sagittal alignment is composed of spinal (LL) and pelvic parameters (PI, PT, and SS);[
Despite these reported relationships between lumbopelvic parameters and SI joint pain/residual pain after lumbar fusion (as noted above), the details surrounding lumbar fusion have been limited. In particular, the relationship between the extent of fusion (the number of instrumented levels) and its potential influence on lumbopelvic parameters has not been heavily explored. Shin et al.[
In our study, analysis of the preoperative values revealed a significant difference between the L3–L5 fusion group and the L4–S1 fusion group, but no other significant differences among other groups. The trend may be partly explained since our patient population had varying underlying pathologies, which according to Jackson et al.,[
The study had several limitations. The patient population possessed different diagnoses, which may distort the comparison among preoperative values. Moreover, the study was a retrospective analysis.
Based on the prior studies, lumbopelvic parameters, particularly LL, SS, and PT, may correlate with SI joint pain/residual pain after lumbar fusion. However, the details surrounding lumbar fusion in those studies have been limited. In particular, the relationship between the extent of fusion (the number of instrumented levels) and its potential influence on lumbopelvic parameters has not been heavily explored. Since strategies toward lumbar fusion may influence the development of SI joint pain postoperatively, investigation of this relationship may shed light on the mechanism for the development of SI joint pain. This study suggests that the extent of instrumentation may not alter lumbopelvic parameters, and implies that the extent of instrumentation may not contribute to SI joint pain.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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