Intraoperative and Postoperative Segmental Lordosis Mismatch: Analysis of 3 Fusion Techniques

Luca Ricciardi, Vito Stifano, Luca Proietti, Andrea Perna, Giuseppe Maria Della Pepa, Giuseppe La Rocca, Alessandro Olivi, Filippo Maria Polli

Research output: Contribution to journalArticle

Abstract

Objective: This study aimed to quantify the discrepancy between intraoperative and postoperative segmental lordosis in patients operated on for lumbar degenerative diseases, with 3 different fixation techniques: open posterolateral instrumentation alone (PLI) or in association with lumbar interbody cages (transforaminal lumbar interbody fusion [TLIF] or extreme lateral interbody fusion [XLIF]). Methods: We retrospectively reviewed all adult patients affected by single-segment degenerative spondylotic disease who underwent PLI alone or percutaneous posterolateral instrumentation (pPLI) in association with TLIF or XLIF between April 2015 and December 2017 at our institution. Group I included patients who underwent PLI with transpedicular screws and rods, interlaminar bilateral decompression, and posterolateral fusion with autologous bone chips. Group II included patients treated with pPLI + TLIF using a complete unilateral arthrectomy. Group III included patients operated on with minimally invasive retroperitoneal pPLI + XLIF. Results: No major complications were reported. The mean segmental loss of lordosis values ranged from 9.17% to 12.28% in Group I, from 6.31%–9.43% in Group II, and from 3.05%–4.71% in Group III. The statistical analysis revealed that pPLI + XLIF maintained a higher segmental lordosis than PLI and pPLI +TLIF in each operated segment (P < 0.05). pPLI + TLIF was more effective than PLI in reducing the loss of lordosis at L4-L5 and at L5-S1 (P < 0.05) but not at L3-L4 (P = 0.12). Conclusions: The documented mismatch between the preoperative and postoperative lumbar lordosis might affect the clinical outcome. Its relevance depends on the surgical technique used at the single level.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Keywords

  • Intraoperative
  • Mismatch
  • Postoperative
  • Segmental lordosis
  • Spinal fusion

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Ricciardi, L., Stifano, V., Proietti, L., Perna, A., Della Pepa, G. M., La Rocca, G., Olivi, A., & Polli, F. M. (Accepted/In press). Intraoperative and Postoperative Segmental Lordosis Mismatch: Analysis of 3 Fusion Techniques. World Neurosurgery. https://doi.org/10.1016/j.wneu.2018.04.126