Preoperative and Postoperative Segmental and Overall Range of Motion in Patients Undergoing Lumbar Spinal Fusion

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

GK

Gregory Kazarian, MD

Hospital for Special Surgery, United States

Co-Author(s)

JD

Jerry Du, MD

Hospital for Special Surgery, United States
PS

Pratyush Shahi, MBBS

Hospital for Special Surgery
New York, New York, United States

Presenting Author (Person doing the Podium Present(s)

TA

Tomoyuki Asada, MD

Hospital for Special Surgery, United States

Co-Author(s)

AL

Amy Lu, BS

United States
MK

Maximillian Korsun, BS

Hospital for Special Surgery, United States
OT

Olivia Tuma, BS

Hospital for Special Surgery
New York, New York, United States
NS

Nishtha Singh, MBBS

hospital for special surgery, United States
KA

Kasra Araghi, BS

Research Fellow
Hospital for Special Surgery
Scottsdale, Arizona, United States
OM

Omri Maayan, BS

Hospital for Special Surgery, United States
SS

Sumedha Singh, MD, MBBS

Hospital for Special Surgery, United States
SI

Sravisht Iyer, MD

Assistant Attending, Spine Surgery
Hospital for Special Surgery
New York, New York, United States

View E-Poster

Submitter(s)

SI

Sravisht Iyer, MD

Assistant Attending, Spine Surgery
Hospital for Special Surgery
New York, New York, United States

View E-Poster

Disclosure(s):

Tomoyuki Asada, MD: No financial relationships to disclose

Nishtha Singh, MBBS: No financial relationships to disclose

Omri Maayan, BS: No financial relationships to disclose

Sravisht Iyer, MD: No financial relationships to disclose

Introduction
Changes in segmental motion and overall lumbar spine motion following single-level interbody fusion may play a role in adjacent segment disease, spine mobility, and postoperative spine biomechanics.
Aims/Objectives
The purpose of this study was to evaluate changes in segmental lumbar motion at each level, as well as overall lumbar alignment (L1 to S1), following single-level lumbar fusion.
Methods
This study was a retrospective multi-center observational radiographic analysis including 50 patients who underwent single-level anterior lumbar interbody fusion (ALIF), thoracolumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), or lateral lumbar interbody fusion (LLIF) (ALIF/TLIF/PLIF/LLIF: 38%/26%/22%/14%; L2-3/L3-4/L4-5/L5-S1: 4%/14%/36%/46%). Preoperative and postoperative flexion-extension images of the lumbar spine were independently analyzed by an imaging core lab using a validated, highly accurate algorithm to calculate the segmental range of motion from L1-2 to L5-S1 and the overall lumbar range of motion (L1-S1).
Results
The average preoperative segmental range of motion (ROM) at each segmental level from L1-2 to L5-S1 was determined to 5.9°, 5.3°, 4.8°, 4.8°, and 4.8°, respectively. Overall L1-S1 preoperative alignment was 25.5º. At 6 months postoperative, the overall L1-S1 ROM decreased by 14% (25.5º to 22.2º. The spinal segments 1 level cranial to the fusion level averaged a 1.5º increase in ROM, while the level one caudal experienced a decrease in ROM of 0.6. Successful fusion was verified in 96% of all instrumented segments already 6 months postoperatively (ROM < 4°).
Conclusions
Following single-level lumbar interbody fusion, surgeons and physicians should expect a minimal loss of only 3.3º, or 14% of overall lumbar motion, at 6 months. Future studies in larger samples should focus on the impact of interbody type and fusion level on segmental and overall ROM postoperatively.