J Korean Soc Spine Surg.  2013 Jun;20(2):51-57. 10.4184/jkss.2013.20.2.51.

Restoration of Lumbar Lordosis After Posterior Lumbar Interbody Fusion with 4 Degree Cage in Degenerative Spinal Disease

• Cho KJ
• Kim YT
• Park SR
• Hong SH

• KMID: 1430375
• DOI: http://doi.org/10.4184/jkss.2013.20.2.51

Abstract

STUDY DESIGN: Retrospective radiological evaluation.
OBJECTIVES
This purpose of this study is to determine how much lumbar lordosis and disc heights are restored after posterior lumbar interbody fusion (PLIF) with cage in degenerative spinal disease. SUMMARY OF LITERATURE REVIEW: Restoration of lumbar lordosis in lumbar spine surgery is crucial for clinical outcomes, but there are few studies about the relationship between restoration of lumbar lordosis and cage. MATERIAL AND METHOD: Eighty-one patients with degenerative spinal diseases underwent PLIF using metal cage with 4degrees lordotic angle. The mean age was 61 year-old (range 38-83 years). Cases with late complications including nonunion, subsidence of cage and instrument failure were excluded in this study. Lumbar lordosis, segmental lordosis, disc height, and sagittal alignment were analyzed on radiographs.
RESULTS
The fused level was one segment in 62 patients and two segments in 19 patients. All patients had the fusion from L3 to the sacrum. Preoperative lumbar lordosis was 34.2degrees, improved to 34.6degrees after surgery, and then changed to 32.2degrees at the final follow-up, demonstrating that the cage with 4degrees lordotic angle was not effective to restore lumbar lordosis. Segmental lordosis at the level of cage decreased at the final follow-up as compared to preoperative value at all segments. Disc height was improved at the final follow-up as compared to preoperative value.
CONCLUSION
Disc height was restored after PLIF using cage in the surgery for degenerative lumbar spine. However, lumbar lordosis and segmental lordosis were decreased at the final follow-up as compared to preoperative lordosis.

Keyword

Posterior lumbar interbody fusion; Cage; Lumbar Lordosis; Segmental Lordosis; Disc Height

MeSH Terms

Animals
Follow-Up Studies
Humans
Lordosis
Retrospective Studies
Sacrum
Spinal Diseases
Spine

Figure

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  Fig. 1. Measurement method of disc height. The midpoint between the 2 posterior corners and the midpoints between the 2 anterior corners were computed. A bisectrix of the sagittal plane angle between the vertebra's midplane was computed and the perpendicular distances to the upper vertebra's lower anterior corner and the lower vertebra's upper anterior corner determined.

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  Fig 2. Loss of lumbar lordosis after posterior lumbar interbody fusion for the patient with spinal stenosis. (A) On preoperative x-ray lumbar lordosis was 32.7˚ and segmental lordosis at L45 was 7.4˚. (B) At the final followup, lumbar lordosis was 25.3˚ and segmental lordosis was 4.3˚ with significant loss of lordosis.

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