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Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion

Rothenfluh, Dominique ; Mueller, Daniel ; Rothenfluh, Esin ; Min, Kan

In: European Spine Journal, 2015, vol. 24, no. 6, p. 1251-1258

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    Titel
    • Pelvic incidence-lumbar lordosis mismatch predisposes to adjacent segment disease after lumbar spinal fusion
    Autor
    • Rothenfluh, Dominique. Department of Orthopaedics, Uniklinik Balgrist, University of Zurich, Zurich, Switzerland
    • Mueller, Daniel. Department of Orthopaedics, Uniklinik Balgrist, University of Zurich, Zurich, Switzerland
    • Rothenfluh, Esin. Department of Orthopaedics, Uniklinik Balgrist, University of Zurich, Zurich, Switzerland
    • Min, Kan. Department of Orthopaedics, Uniklinik Balgrist, University of Zurich, Zurich, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • European Spine Journal, 2015, vol. 24, no. 6, p. 1251-1258. Springer Berlin Heidelberg
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:331388
    Summary
    Purpose: Several risk factors and causes of adjacent segment disease have been debated; however, no quantitative relationship to spino-pelvic parameters has been established so far. A retrospective case-control study was carried out to investigate spino-pelvic alignment in patients with adjacent segment disease compared to a control group. Methods: 45 patients (ASDis) were identified that underwent revision surgery for adjacent segment disease after on average 49months (7-125), 39 patients were selected as control group (CTRL) similar in the distribution of the matching variables, such as age, gender, preoperative degenerative changes, and numbers of segments fused with a mean follow-up of 84months (61-142) (total n=84). Several radiographic parameters were measured on pre- and postoperative radiographs, including lumbar lordosis measured (LL), sacral slope, pelvic incidence (PI), and tilt. Results: Significant differences between ASDis and CTRL groups on preoperative radiographs were seen for PI (60.9±10.0° vs. 51.7±10.4°, p=0.001) and LL (48.1±12.5° vs. 53.8±10.8°, p=0.012). Pelvic incidence was put into relation to lumbar lordosis by calculating the difference between pelvic incidence and lumbar lordosis (∆PILL=PI−LL, ASDis 12.5±16.7° vs. CTRL 3.4±12.1°, p=0.001). A cutoff value of 9.8° was determined by logistic regression and ROC analysis and patients classified into a type A (∆PILL <10°) and a type B (∆PILL ≥10°) alignment according to pelvic incidence-lumbar lordosis mismatch. In type A spino-pelvic alignment, 25.5% of patients underwent revision surgery for adjacent segment disease, whereas 78.3% of patients classified as type B alignment had revision surgery. Classification of patients into type A and B alignments yields a sensitivity for predicting adjacent segment disease of 71%, a specificity of 81% and an odds ratio of 10.6. Conclusion: In degenerative disease of the lumbar spine a high pelvic incidence with diminished lumbar lordosis seems to predispose to adjacent segment disease. Patients with such pelvic incidence-lumbar lordosis mismatch exhibit a 10-times higher risk for undergoing revision surgery than controls if sagittal malalignment is maintained after lumbar fusion surgery.