Relationship between sagittal balance and adjacent segment disease in surgical treatment of degenerative lumbar spine disease: meta-analysis and implications for choice of fusion technique

Relationship between sagittal balance and adjacent segment disease in surgical treatment of degenerative lumbar spine disease: meta-analysis and implications for choice of fusion technique

Kevin Phan, Alexander Nazareth, Awais K. Hussain, Adam A. Dmytriw, Mithun Nambiar, Damian Nguyen, Jack Kerferd, Steven Phan, Chet Sutterlin III, Samuel K. Cho, Ralph J. Mobbs

August 2018, Volume 27, Issue 8, pp 1981 - 1991
DOI
10.1007/s00586-018-5629-6
First Online: 28 May 2018
Abstract

Study design

Meta-analysis.

Objective

To conduct a meta-analysis investigating the relationship between spinopelvic alignment parameters and development of adjacent level disease (ALD) following lumbar fusion for degenerative disease.

Summary of background data

ALD is a degenerative pathology that develops at mobile segments above or below fused spinal segments. Patient outcomes are worse, and the likelihood of requiring revision surgery is higher in ALD compared to patients without ALD. Spinopelvic sagittal alignment has been found to have a significant effect on outcomes post-fusion; however, studies investigating the relationship between spinopelvic sagittal alignment parameters and ALD in degenerative lumbar disease are limited.

Methods

Six e-databases were searched. Predefined endpoints were extracted and meta-analyzed from the identified studies.

Results

There was a significantly larger pre-operative PT in the ALD cohort versus control (WMD 3.99, CI 1.97–6.00, p = 0.0001), a smaller pre-operative SS (WMD − 2.74; CI − 5.14 to 0.34, p = 0.03), and a smaller pre-operative LL (WMD − 4.76; CI − 7.66 to 1.86, p = 0.001). There was a significantly larger pre-operative PI-LL in the ALD cohort (WMD 8.74; CI 3.12–14.37, p = 0.002). There was a significantly larger postoperative PI in the ALD cohort (WMD 2.08; CI 0.26–3.90, p = 0.03) and a larger postoperative PT (WMD 5.23; CI 3.18–7.27, p 

Conclusion

The sagittal parameters: PT, SS, PI-LL, and LL may predict development of ALD in patients’ post-lumbar fusion for degenerative disease. Decision-making aimed at correcting these parameters may decrease risk of developing ALD in this cohort.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.]