Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2022; 10(35): 12880-12889
Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.12880
Radiological and clinical outcomes of midline lumbar fusion on sagittal lumbar-pelvic parameters for degenerative lumbar diseases
Yue-Tian Wang, Bing-Xu Li, Shi-Jun Wang, Chun-De Li, Hao-Lin Sun
Yue-Tian Wang, Bing-Xu Li, Shi-Jun Wang, Chun-De Li, Hao-Lin Sun, Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
Author contributions: Wang YT and Li BX contributed equally to this work; Wang YT and Li BX collected the radiographic and clinical data and contributed to the manuscript drafting; Wang YT analyzed and interpreted the imaging findings; Wang YT and Li BX carried out the statistical analysis; Wang SJ, Li CD and Sun HL performed the spine surgery; Sun HL was responsible for the revision of the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Human Subjects Institutional Review Board of Peking University First Hospital, No. 2022 Yan 359-001.
Informed consent statement: Patient were not required to give informed consent to the study because the analysis used anonymous clinical data.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: Original data is available from the corresponding author at sunhaolin@vip.163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao-Lin Sun, MD, Associate Professor, Department of Orthopedics, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China. sunhaolin@vip.163.com
Received: August 11, 2022
Peer-review started: August 11, 2022
First decision: September 25, 2022
Revised: October 7, 2022
Accepted: November 17, 2022
Article in press: November 17, 2022
Published online: December 16, 2022
Abstract
BACKGROUND

Improving the sagittal lumbar-pelvic parameters after fusion surgery is important for improving clinical outcomes. The impact of midline lumbar fusion (MIDLF) on sagittal lumbar-pelvic alignment for the management of degenerative lumbar diseases is still unknown.

AIM

To analyze the effects of short-segment MIDLF and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) on sagittal lumbar-pelvic parameters.

METHODS

We retrospectively analyzed 63 patients with degenerative lumbar diseases who underwent single-segment MIDLF or MIS-TLIF. The imaging data of patients were collected before surgery and at the final follow-up. The radiological sagittal parameters included the lumbar lordosis (LL), lower LL, L4 slope (L4S), L5 slope (L5S), L5 incidence (L5I), L1 axis and S1 distance (LASD), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and PI-LL mismatch (PI-LL). Additionally, the clinical outcomes, including lower back and leg pain visual analog scale (VAS) and Oswestry disability index (ODI) scores, were also analyzed.

RESULTS

In both groups, LL and Lower LL significantly increased, while L5I and LASD significantly decreased at the final follow-up compared to that recorded prior to operation (P < 0.05). In the MIDLF group, L4S significantly decreased compared to that recorded prior to operation (P < 0.05), while the mean SS significantly increased and the PT significantly decreased compared to that recorded prior to operation (P < 0.05). In the MIS-TLIF group, SS slightly increased and the mean PT value decreased compared to that recorded prior to operation, but without a statistically significant difference (P > 0.05). However, the PI-LL in both groups was significantly reduced compared to that recorded prior to operation (P < 0.05). There was no significant difference in the sagittal lumbar-pelvic parameters between the two groups prior to operation and at the final follow-up (P > 0.05). In addition, the change in sagittal lumbar-pelvic parameters did not differ significantly, except for ΔLASD within the two groups (P > 0.05). The mean lower back and leg pain VAS and ODI scores in both groups were significantly improved three months after surgery and at the final follow-up. Though the mean ODI score in the MIDLF group three months after surgery was slightly higher than that in the MIS-TLIF group, there was no significant difference between the two groups at the final follow-up.

CONCLUSION

Short-segment MIDLF and MIS-TLIF can equally improve sagittal lumbar parameters such as LL, Lower LL, L5I, and LASD in the treatment of lumbar degenerative diseases. However, MIDLF had a larger impact on pelvic parameters than MIS-TLIF.

Keywords: Minimally invasive, Interbody fusion, Cortical bone trajectory, Sagittal lumbar-pelvic parameters

Core Tip: It is important for clinical outcomes to improve the sagittal lumbar-pelvic parameters after fusion surgery. However, whether midline lumbar fusion (MIDLF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) differ in the impact of the sagittal lumbar-pelvic alignment for degenerative lumbar diseases is still unknown. The current study compared the imaging data and clinical efficacy of MIDLF with those of MIS-TLIF to evaluate the impact of the two procedures on the sagittal lumbar-pelvic parameters in the treatment of lumbar degenerative diseases.