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Factors Affecting Incomplete L5/S Posterior Lumbar Interbody Fusion, Including Spinopelvic Sagittal Parameters
Shinichi Kato1, Nobuki Terada1, Osamu Niwa1
1Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, School of Medicine, Fujita Health University, Nagoya, Japan.
Asian Spine Journal
|September 1, 2021
Summary
Incomplete posterior lumbar interbody fusion (PLIF) at L5/S is linked to older age, multiple fusion levels, and specific disk angle changes. Understanding these factors can improve fusion success rates.
Area of Science:
- Spine surgery
- Orthopedic research
- Fusion techniques
Background:
- The lumbosacral (L5/S) junction has a lower interbody fusion rate compared to the lumbar spine.
- Pelvic morphology's impact on L5/S interbody fusion remains under-investigated.
- This study explores factors influencing L5/S posterior lumbar interbody fusion (PLIF) outcomes.
Purpose of the Study:
- Identify risk factors for incomplete L5/S PLIF.
- Analyze patient demographics, sagittal parameters, and clinical findings.
- Determine predictors of successful L5/S interbody fusion.
Main Methods:
- Retrospective observational study of 141 patients undergoing L5/S PLIF.
- Investigated factors: age, gender, DISH, fusion level, osteotomy grade, L5/S disk height/angle, lordosis, VAS, JOA, and pelvic incidence (PI).
- Compared patients with and without L5/S interbody fusion, analyzing short-level vs. multi-level fusion groups.
Main Results:
- Overall L5/S interbody fusion rate was 70% (short-level: 78%, multi-level: 40%).
- Age and L5/S disk angles (pre- and post-preoperative) significantly differed by fusion level.
- DISH, osteotomy grade, postoperative VAS/JOA scores were significant in short-level fusion; PI was significant in multi-level fusion.
Conclusions:
- Incomplete L5/S PLIF is associated with advanced age and multiple fusion levels.
- Preoperative and post-preoperative L5/S disk angles are critical factors.
- Pelvic incidence is a significant factor in multi-level fusion outcomes.
