Effect of Sagittal Balance on Risk of Falling after Lateral Lumbar Interbody Fusion Surgery Combined with Posterior Surgery
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Purpose: To demonstrate the impact of correcting sagittal balance (SB) on functional outcomes of surgical treatment for degenerativespinal disease and actual falls via utilization of new minimally invasive lumbar fusion techniques via a lateral approach. Materials and Methods: From November 2011 to March 2015, we enrolled 56 patients who underwent minimally invasive lateral lumbar interbody fusion (LLIF) and matched 112 patients receiving decompression/postero-lateral fusion (PLF) surgery for lumbarspinal stenosis. According to SB status using C7-plumb line-distance (C7PL) and surgery type, patients were divided into three groups: SB PLF, sagittal imbalance (SI) PLF, and LLIF groups. We then compared their outcomes. Results: The mean C7PL was 6.2±13.6 mm in the SB PLF group, 72.9±33.8 mm in the SI PLF group, and 74.8±38.2 mm in the LLIF group preoperatively. Postoperatively, C7PL in only the LLIF group improved significantly (p=0.000). Patients in the LLIF group showed greater improvement in fall-related functional test scores than the SI PLF group (p=0.007 for Alternate-Step test, p=0.032 for Sit-to-Stand test). The average number of postoperative falls was 0.4±0.7 in the SB PLF group, 1.1±1.4 in the SI PLF group, and 0.8±1.0 in the LLIF group (p=0.041). Oswestry Disability Index and the Euro-QoL 5 dimension visual analogue scale scores also showed greater improvements in the LLIF group than in the SI PLF group at postoperative 1 year (p=0.003, 0.016). Conclusion: Surgical correction of SI in patients with lumbar spinal stenosis using a combination of minimal invasive LLIF and posterior surgery achieved better surgical outcomes and a lower incidence of actual falls than PLF surgery.
Abstract
Purpose: To demonstrate the impact of correcting sagittal balance (SB) on functional outcomes of surgical treatment for degenerativespinal disease and actual falls via utilization of new minimally invasive lumbar fusion techniques via a lateral approach. Materials and Methods: From November 2011 to March 2015, we enrolled 56 patients who underwent minimally invasive lateral lumbar interbody fusion (LLIF) and matched 112 patients receiving decompression/postero-lateral fusion (PLF) surgery for lumbarspinal stenosis. According to SB status using C7-plumb line-distance (C7PL) and surgery type, patients were divided into three groups: SB PLF, sagittal imbalance (SI) PLF, and LLIF groups. We then compared their outcomes. Results: The mean C7PL was 6.2±13.6 mm in the SB PLF group, 72.9±33.8 mm in the SI PLF group, and 74.8±38.2 mm in the LLIF group preoperatively. Postoperatively, C7PL in only the LLIF group improved significantly (p=0.000). Patients in the LLIF group showed greater improvement in fall-related functional test scores than the SI PLF group (p=0.007 for Alternate-Step test, p=0.032 for Sit-to-Stand test). The average number of postoperative falls was 0.4±0.7 in the SB PLF group, 1.1±1.4 in the SI PLF group, and 0.8±1.0 in the LLIF group (p=0.041). Oswestry Disability Index and the Euro-QoL 5 dimension visual analogue scale scores also showed greater improvements in the LLIF group than in the SI PLF group at postoperative 1 year (p=0.003, 0.016). Conclusion: Surgical correction of SI in patients with lumbar spinal stenosis using a combination of minimal invasive LLIF and posterior surgery achieved better surgical outcomes and a lower incidence of actual falls than PLF surgery.
참고문헌 (41)
- Berven SH, "Management of fixed sagittal plane deformity: outcome of combined anterior and posterior surgery", Spine (Phila Pa 1976), 28, pp.1710~1715 (2003)
- Bayerl SH, "The sagittal balance does not influence the 1 year clinical outcome of patients with lumbar spinal stenosis without obvious instability after microsurgical decompression", Spine (Phila Pa 1976), 40, pp.1014~1021 (2015)
- Hikata T, "Impact of sagittal spinopelvic alignment on clinical outcomes after decompression surgery for lumbar spinal canal stenosis without coronal imbalance", J Neurosurg Spine, 23, pp.451~458 (2015)
- Kawakami M, "Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis", Spine (Phila Pa 1976), 27, pp.59~64 (2002)
- Costanzo G, "The role of minimally invasive lateral lumbar interbody fusion in sagittal balance correction and spinal deformity", Eur Spine J, 23(Suppl 6), pp.699~704 (2014)
- Kotwal S, "Minimally invasive lateral lumbar interbody fusion: clinical and radiographic outcome at a minimum 2-year follow-up", J Spinal Disord Tech, 28, pp.119~125 (2015)
- Resnick DK, "Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10:lumbar fusion for stenosis without spondylolisthesis", J Neurosurg Spine, 21, pp.62~66 (2014)
- Resnick DK, "Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9:lumbar fusion for stenosis with spondylolisthesis", J Neurosurg Spine, 21, pp.54~61 (2014)
- Rampersaud YR, "Assessment of health-related quality of life after surgical treatment of focal symptomatic spinal stenosis compared with osteoarthritis of the hip or knee", Spine J, 8, pp.296~304 (2008)
- Tiedemann A, "The comparative ability of eight functional mobility tests for predicting falls in community-dwelling older people", Age Ageing, 37, pp.430~435 (2008)
- Villareal DT, "Weight loss, exercise, or both and physical function in obese older adults", N Engl J Med, 364, pp.1218~1229 (2011)
- Lee SM, "Effect of correction of the contractured flexed osteoarthritic knee on the sagittal alignment by total replacement", Asian Spine J, 7, pp.204~211 (2013)
- Morvan G, "Standardized way for imaging of the sagittal spinal balance", Eur Spine J, 20(Suppl 5), pp.602~608 (2011)
- Jackson RP, "Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study", Spine (Phila Pa 1976), 19, pp.1611~1618 (1994)
- Legaye J, "Pelvic incidence:a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves", Eur Spine J, 7, pp.99~103 (1998)
- Tsutsumimoto T, "Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis", Eur Spine J, 17, pp.1107~1112 (2008)
- Williams AL, "CT evaluation of lumbar interbody fusion: current concepts", AJNR Am J Neuroradiol, 26, pp.2057~2066 (2005)
- Solberg TK, "Health-related quality of life assessment by the EuroQol-5D can provide cost-utility data in the field of low-back surgery", Eur Spine J, 14, pp.1000~1007 (2005)
- Fairbank JC, "The Oswestry Disability Index", Spine (Phila Pa 1976), 25, pp.2940~2952 (2000)
- 문성환, "Surgical Outcome Predictor in Degenerative Lumbar Spinal Disease Based on Health Related Quality of Life Using Euro-Quality 5 Dimensions Analysis", Yonsei Medical Journal, 57(5), pp.1214~1221 (2016), 연세대학교의과대학
- Kellgren JH, "Osteoarthrosis in patients and populations", Br Med J, 2, pp.1~6 (1961)
- Binkley N, "Lateral vertebral assessment: a valuable technique to detect clinically significant vertebral fractures", Osteoporos Int, 16, pp.1513~1518 (2005)
- Kim HJ, "The risk assessment of a fall in patients with lumbar spinal stenosis", Spine (Phila Pa 1976), 36, pp.E588~E592 (2011)
- Lee BH, "Comparison of effects of nonoperative treatment and decompression surgery on risk of patients with lumbar spinal stenosis falling: evaluation with functional mobility tests", J Bone Joint Surg Am, 96, pp.e110~ (2014)
- Seiji Ohtori, "Mini-Open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lateral Interbody Fusion for Lumbar Spinal Degeneration Disease", Yonsei Medical Journal, 56(4), pp.1051~1059 (2015), 연세대학교의과대학[DOI]
- Baghdadi YM, "Sagittal balance and spinopelvic parameters after lateral lumbar interbody fusion for degenerative scoliosis: a case-control stu", Spine (Phila Pa 1976), 39, pp.E166~E173 (2014)
- Phan K, "Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity", J Clin Neurosci, 22, pp.1714~1721 (2015)
- Imagama S, "Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males", Eur Spine J, 22, pp.1346~1353 (2013)
- Lee BH, "Spinal sagittal balance status affects postoperative actual falls and quality of life after decompression and fusion in-situ surgery in patients with lumbar spinal stenosis", Clin Neurol Neurosurg, 148, pp.52~59 (2016)
- Jean L, "Influence of age and sagittal balance of the spine on the value of the pelvic incidence", Eur Spine J, 23, pp.1394~1399 (2014)
- Lamartina C, "Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms", Eur Spine J, 23, pp.1177~1189 (2014)
- Diebo BG, "Recruitment of compensatory mechanisms in sagittal spinal malalignment is age and regional deformity dependent: a full-standing axis analysis of key radiographical parameters", Spine (Phila Pa 1976), 40, pp.642~649 (2015)
- Schwab FJ, "Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis", Spine (Phila Pa 1976), 38, pp.E803~E812 (2013)
- Bao H, "Will immediate postoperative imbalance improve in patients with thoracolumbar", lumbar degenerative kyphoscoliosis? A comparison between Smith-Petersen osteotomy and pedicle subtraction osteotomy with an average 4 years of follow-up, 2015, pp.40, E293~E300
- 김신재, "Clinical and Radiological Outcomes of a New Cage for Direct Lateral Lumbar Interbody Fusion", 대한척추신경외과학회지, 11(3), pp.145~151 (2014), 대한척추신경외과학회[DOI]
- Katz JN, "Degenerative lumbar spinal stenosis. Diagnostic value of the history and physical examination", Arthritis Rheum, 38, pp.1236~1241 (1995)
- Koller H, "Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients", Eur Spine J, 25, pp.532~548 (2016)
- Chung MM, "Reliability and validity of Alternate Step Test times in subjects with chronic stroke", J Rehabil Med, 46, pp.969~974 (2014)
- Barrey C, "Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms?", Eur Spine J, 20(Suppl 5), pp.626~633 (2011)
- 남우동, "Clinical and Radiological Predictive Factors to be Related with the Degree of Lumbar Back Muscle Degeneration: Difference by Gender", Clinics in Orthopedic Surgery, 6(3), pp.318~323 (2014), 대한정형외과학회
- Hobbs AJ, "Comparison of lumbar proprioception as measured in unrestrained standing in individuals with disc replacement, with low back pain, and without low back pain", J Orthop Sports Phys Ther, 40, pp.439~446 (2010)
