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Lumbar sagittal alignment after fusion with a threaded interbody cage
J A Goldstein1, M J Macenski, S L Griffith
1Department of Orthopaedic Surgery, Seaport Orthopaedic Associates Spine Center, New York University-Hospital for Joint Diseases, New York 10038, USA.jeff.goldstein@med.nyu.edu
Spine
|June 20, 2001
Summary
Lumbar interbody fusion with cylindrical cages maintains normal lumbar lordosis and improves patient outcomes. Changes in lordosis after surgery do not correlate with clinical results, indicating the procedure is safe and effective for spinal alignment.
Area of Science:
- Spine surgery
- Orthopedics
- Neurosurgery
Background:
- Lumbar lordosis is crucial for spinal sagittal alignment and balance, particularly in the L4-S1 region.
- Maintaining anatomically correct lumbar lordosis is considered essential, as its loss may contribute to spinal pathology.
- Limited data exists regarding lumbar lordosis changes following interbody fusion procedures.
Purpose of the Study:
- To evaluate changes in lumbar spine sagittal alignment and clinical outcomes after interbody fusion surgery.
- To assess the impact of interbody fusion cages on lumbar lordosis.
- To correlate lordotic angle changes with clinical outcomes at a 2-year follow-up.
Main Methods:
- Retrospective assessment of 111 patients (126 operative levels) who received interbody fusion cages (BAK/L trial).
- Analysis of lateral radiographs to measure segmental lordosis before and 2 years after surgery.
- Correlation of segmental lordotic changes with clinical outcomes, considering surgical approach (anterior vs. posterior).
Main Results:
- Preoperative lordosis varied based on surgical approach.
- A significant decrease in lordosis was observed at 2 years in the posterior approach group, though angles remained within normal ranges.
- Clinical outcomes significantly improved at 2 years post-surgery, with no correlation found between lordotic changes and outcomes.
Conclusions:
- Interbody lumbar fusion using threaded cylindrical cages maintains segmental lordosis within normal anatomical limits.
- The procedure leads to significant improvements in clinical outcomes.
- Post-surgical changes in lumbar lordotic angles do not predict clinical outcomes.