Lumbar alignment and patient-reported outcomes after single-level transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with and without local coronal imbalance

Wei Pan MD, Jia-li Zhao MD, Jin Xu MD, Ming Zhang MD, Tao Fang MD, Jing Yan MD, Xin-hong Wang MD, and Quan Zhou MD
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  • Department of Orthopedics, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, Huai’an, China
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OBJECTIVE

The purpose of this study was to compare the preoperative radiographic features of degenerative lumbar spondylolisthesis (DLS) with and without local coronal imbalance (LCI) and to investigate the surgical outcomes of transforaminal lumbar interbody fusion (TLIF) in the treatment of DLS with LCI at the spondylolisthesis level. DLS with scoliotic disc wedging and/or lateral listhesis at the same involved segment, as well as LCI, constitutes a distinct subgroup. However, previous studies concerning surgical outcomes focused mainly on sagittal profiles. There is a paucity of valid data regarding lumbar coronal alignment and patient-reported outcomes (PROs) after surgery in DLS with LCI.

METHODS

The authors reviewed consecutive patients who received TLIF for L4/5 DLS between 2009 and 2018. Patients were assigned to the LCI and non-LCI groups based on preoperative radiographs. Demographics, radiographic parameters related to both sagittal and coronal alignment, and PROs were compared between the 2 groups.

RESULTS

There were 21 patients in the LCI and 80 in the non-LCI group. Compared with the non-LCI group, the LCI group was characterized by lower preoperative lumbar lordosis on sagittal alignment (38.3° vs 43.7°, p < 0.05), higher lumbar Cobb angle on coronal alignment (12.4° vs 5.1°, p < 0.05), and worse lumbar coronal balance (18.5 mm vs 6.8 mm, p < 0.05). After surgery, lumbar alignment in the sagittal and coronal planes was significantly improved in the LCI group, whereas no significant changes occurred in the non-LCI group. Scores on the preoperative Oswestry Disability Index and the visual analog scale for back pain and leg pain scores were significantly higher in the LCI group, whereas no differences were found between the 2 groups in the postoperative evaluation (p > 0.05).

CONCLUSIONS

DLS with LCI constitutes a distinct subgroup characterized by coronal malalignment and loss of whole lumbar lordosis, which may result in worse PROs. The TLIF procedure allows the reconstruction of the coronal and sagittal lumbar profile and achievement of satisfactory PROs.

ABBREVIATIONS DLS = degenerative lumbar spondylolisthesis; LCI = local coronal imbalance; ODI = Oswestry Disability Index; PRO = patient-reported outcome; TLIF = transforaminal lumbar interbody fusion; VAS-BP, VAS-LP = visual analog scale for back pain, visual analog scale for leg pain.

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Contributor Notes

Correspondence Quan Zhou: The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People’s Hospital of Huai’an, China. nick0908@sina.com.

INCLUDE WHEN CITING Published online December 4, 2020; DOI: 10.3171/2020.7.SPINE20703.

W.P. and J.L.Z. contributed equally to this article.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Watters WC III, Bono CM, Gilbert TJ, An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J. 2009;9(7):609614.

    • Search Google Scholar
    • Export Citation
  • 2

    Zhu C, Qiu X, Zhuang M, Surgical outcomes of single-level transforaminal lumbar interbody fusion for degenerative spondylolisthesis with and without kyphotic alignment. World Neurosurg. 2018;117:e396e402.

    • Search Google Scholar
    • Export Citation
  • 3

    Chen X, Xu L, Qiu Y, Higher improvement in patient-reported outcomes can be achieved after transforaminal lumbar interbody fusion for clinical and radiographic degenerative spondylolisthesis classification type D degenerative lumbar spondylolisthesis. World Neurosurg. 2018;114:e293e300.

    • Search Google Scholar
    • Export Citation
  • 4

    Kepler CK, Hilibrand AS, Sayadipour A, Clinical and radiographic degenerative spondylolisthesis (CARDS) classification. Spine J. 2015;15(8):18041811.

    • Search Google Scholar
    • Export Citation
  • 5

    Sobol GL, Hilibrand A, Davis A, Reliability and clinical utility of the CARDS classification for degenerative spondylolisthesis. Clin Spine Surg. 2018;31(1):E69E73.

    • Search Google Scholar
    • Export Citation
  • 6

    Murata Y, Takahashi K, Hanaoka E, Changes in scoliotic curvature and lordotic angle during the early phase of degenerative lumbar scoliosis. Spine (Phila Pa 1976). 2002;27(20):22682273.

    • Search Google Scholar
    • Export Citation
  • 7

    Takahashi T, Hanakita J, Watanabe M, Lumbar alignment and clinical outcome after single level asymmetrical transforaminal lumbar interbody fusion for degenerative spondylolisthesis with local coronal imbalance. Neurol Med Chir (Tokyo). 2014;54(9):691697.

    • Search Google Scholar
    • Export Citation
  • 8

    Kong LD, Zhang YZ, Wang F, Radiographic restoration of sagittal spinopelvic alignment after posterior lumbar interbody fusion in degenerative spondylolisthesis. Clin Spine Surg. 2016;29(2):E87E92.

    • Search Google Scholar
    • Export Citation
  • 9

    Kato M, Namikawa T, Matsumura A, Radiographic risk factors of reoperation following minimally invasive decompression for lumbar canal stenosis associated with degenerative scoliosis and spondylolisthesis. Global Spine J. 2017;7(6):498505.

    • Search Google Scholar
    • Export Citation
  • 10

    Kelleher MO, Timlin M, Persaud O, Rampersaud YR. Success and failure of minimally invasive decompression for focal lumbar spinal stenosis in patients with and without deformity. Spine (Phila Pa 1976). 2010;35(19):E981E987.

    • Search Google Scholar
    • Export Citation
  • 11

    Challier V, Boissiere L, Obeid I, One-level lumbar degenerative spondylolisthesis and posterior approach: is transforaminal lateral interbody fusion mandatory?: a randomized controlled trial with 2-year follow-up. Spine (Phila Pa 1976). 2017;42(8):531539.

    • Search Google Scholar
    • Export Citation
  • 12

    Seo JY, Ha KY, Hwang TH, Risk of progression of degenerative lumbar scoliosis. J Neurosurg Spine. 2011;15(5):558566.

  • 13

    Chen X, Zhou QS, Xu L, Does kyphotic configuration on upright lateral radiograph correlate with instability in patients with degenerative lumbar spondylolisthesis? Clin Neurol Neurosurg. 2018;173:96100.

    • Search Google Scholar
    • Export Citation
  • 14

    Chen IR, Wei TS. Disc height and lumbar index as independent predictors of degenerative spondylolisthesis in middle-aged women with low back pain. Spine (Phila Pa 1976). 2009;34(13):14021409.

    • Search Google Scholar
    • Export Citation
  • 15

    Leone A, Cassar-Pullicino VN, Guglielmi G, Bonomo L. Degenerative lumbar intervertebral instability: what is it and how does imaging contribute? Skeletal Radiol. 2009;38(6):529533.

    • Search Google Scholar
    • Export Citation
  • 16

    Lee N, Yi S, Shin DA, Progression of coronal Cobb angle after short-segment lumbar interbody fusion in patients with degenerative lumbar stenosis. World Neurosurg. 2016;89:510516.

    • Search Google Scholar
    • Export Citation
  • 17

    Kepler CK, Rihn JA, Radcliff KE, Restoration of lordosis and disk height after single-level transforaminal lumbar interbody fusion. Orthop Surg. 2012;4(1):1520.

    • Search Google Scholar
    • Export Citation
  • 18

    Farshad-Amacker NA, Hughes AP, Aichmair A, Determinants of evolution of endplate and disc degeneration in the lumbar spine: a multifactorial perspective. Eur Spine J. 2014;23(9):18631868.

    • Search Google Scholar
    • Export Citation

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