143 - Change in Segmental Lordosis after Different Lumbar Interbody Fusion Techniques: A Systematic Review with Attention to Level Specific Data and Surgeon Intent

Saturday, June 3, 2023

12:04 PM – 12:06 PM

Location: Salons 13-15

Presenting Author (Person doing the Podium Present(s)

CC

Charles H. Crawford, MD

Spine Surgeon
Norton Leatherman Spine Center, United States

Co-Author(s)

GS

Grant O. Schmidt, MD

Norton Leatherman Spine Center
Louisville, Kentucky, United States
JG

James C. Gainer, MD

Resident
University of Louisville Department of Orthopaedic Surgery, United States
LN

Lauren M. Nelson, MD

Resident
University of Louisville Department of Orthopaedic Surgery, United States
JR

Jarod A. Richards, MD

Resident
University of Louisville Department of Orthopaedic Surgery, United States
CK

Camille D. Khalily, MD

University of Louisville School of Medicine, United States

Submitter(s)

GS

Grant O. Schmidt, MD

Norton Leatherman Spine Center
Louisville, Kentucky, United States

Disclosure(s):

Charles H. Crawford, MD: No relevant disclosure to display

Introduction: The clinical importance of segmental lordosis and sagittal alignment in lumbar interbody fusion has been thoroughly demonstrated. However, the ability of various interbody fusion techniques to restore or maintain segmental lordosis is controversial.
Aims/

Objectives: The aim of this study was to compare the degree of segmental lordosis correction for the various interbody fusion techniques with attention to level specific data and surgeon intent.

Methods: PubMed and EBSCO databases were queried for studies from 2010-2020 involving adult patients who underwent lumbar interbody fusion. Segmental and global lordosis, ODI, VAS scores, and level specific data (e.g. L4/L5 vs. L5/S1) and surgeon intent (maintain or increase) for segmental lordosis were recorded. Weighted pooled estimates of segmental and global lumbar lordosis, ODI, and VAS scores were calculated for each surgical approach.

Results: Of 156 articles identified, 35 met inclusion criteria. Mean increases in segmental lumbar lordosis for ALIF, LLIF/XLIF, PLIF, and TLIF were 5.6 (2.5 to 15.0), 4.3 (1.7 to 6.0), 0.9 (-0.8 to 5.0), and 3.0 (-1.9 to 9.3); mean increases in global lumbar lordosis were 6.6 (2.9 to 9.9), 0.4 (-12.2 to 7.8), 1.8 (-1.6 to 3.9), and 0.0 (-1.5 to 26.0); and mean improvements in ODI were 30.1 (21.0 to 35.6), 28.0 (19.8 to 36.0), 17.8 (5.1 to 31.4), and 27.8 (16.6 to 41.4), respectively.

Conclusions: The results of this systematic review show that when analyzing pooled means, ALIF achieves a greater increase in segmental and global lordosis compared to LLIF/XLIF, PLIF or TLIF. However, the upper limit of the ranges suggest that significant lordosis improvement is possible with each technique. When level specific data was reported, ALIF was more commonly performed at L5/S1 while the other techniques were more commonly performed above L5/S1. Surgeon intent to change versus maintain segmental lordosis and the normal anatomic lordosis distribution were not reported.