Yonsei Med J.  2017 Nov;58(6):1177-1185. 10.3349/ymj.2017.58.6.1177.

Effect of Sagittal Balance on Risk of Falling after Lateral Lumbar Interbody Fusion Surgery Combined with Posterior Surgery

Affiliations
  • 1Department of Orthopedic Surgery, College of Medicine, Catholic-Kwandong University, Incheon, Korea.
  • 2Institue for Bio-Medical Convergence, College of Medicine, Catholic-Kwandong University, Incheon, Korea.
  • 3Department of Orthopedic Surgery, College of Medicine, Yonsei University, Seoul, Korea. shmoon@yuhs.ac

Abstract

PURPOSE
To demonstrate the impact of correcting sagittal balance (SB) on functional outcomes of surgical treatment for degenerative spinal disease and actual falls via utilization of new minimally invasive lumbar fusion techniques via a lateral approach.
MATERIALS AND METHODS
From November 2011 to March 2015, we enrolled 56 patients who underwent minimally invasive lateral lumbar interbody fusion (LLIF) and matched 112 patients receiving decompression/postero-lateral fusion (PLF) surgery for lumbar spinal stenosis. According to SB status using C7-plumb line-distance (C7PL) and surgery type, patients were divided into three groups: SB PLF, sagittal imbalance (SI) PLF, and LLIF groups. We then compared their outcomes.
RESULTS
The mean C7PL was 6.2±13.6 mm in the SB PLF group, 72.9±33.8 mm in the SI PLF group, and 74.8±38.2 mm in the LLIF group preoperatively. Postoperatively, C7PL in only the LLIF group improved significantly (p=0.000). Patients in the LLIF group showed greater improvement in fall-related functional test scores than the SI PLF group (p=0.007 for Alternate-Step test, p=0.032 for Sit-to-Stand test). The average number of postoperative falls was 0.4±0.7 in the SB PLF group, 1.1±1.4 in the SI PLF group, and 0.8±1.0 in the LLIF group (p=0.041). Oswestry Disability Index and the Euro-QoL 5 dimension visual analogue scale scores also showed greater improvements in the LLIF group than in the SI PLF group at postoperative 1 year (p=0.003, 0.016).
CONCLUSION
Surgical correction of SI in patients with lumbar spinal stenosis using a combination of minimal invasive LLIF and posterior surgery achieved better surgical outcomes and a lower incidence of actual falls than PLF surgery.

Keyword

Lumbar spinal stenosis; surgery; actual falls; sagittal balance; outcome; lateral lumbar interbody fusion

MeSH Terms

Accidental Falls/*statistics & numerical data
Aged
Aged, 80 and over
Decompression, Surgical/*methods
Exercise Test
Female
Humans
Incidence
Lumbar Vertebrae/*diagnostic imaging/*surgery
Male
Middle Aged
Outcome Assessment (Health Care)
Postoperative Period
Postural Balance
Quality of Life
Radiography
Risk
Spinal Fusion/*methods
Spinal Stenosis/*surgery
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