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World neurosurgery v.115, 2018년, pp.e659 - e663  

Intraoperative and Postoperative Segmental Lordosis Mismatch: Analysis of 3 Fusion Techniques

Ricciardi, Luca (Department of Neurosurgery, Catholic University, Rome, Italy ) ; Stifano, Vito (Department of Neurosurgery, Catholic University, Rome, Italy ) ; Proietti, Luca (Department of Spinal Surgery, Catholic University, Rome, Italy ) ; Perna, Andrea (Department of Spinal Surgery, Catholic University, Rome, Italy ) ; Della Pepa, Giuseppe Maria (Department of Neurosurgery, Catholic University, Rome, Italy ) ; La Rocca, Giuseppe (Department of Neurosurgery, Catholic University, Rome, Italy ) ; Olivi, Alessandro (Department of Neurosurgery, Catholic University, Rome, Italy ) ; Polli, Filippo Maria (Department of Neurosurgery, Catholic University, Rome, Italy ) ;
  • 초록  

    Objective This study aimed to quantify the discrepancy between intraoperative and postoperative segmental lordosis in patients operated on for lumbar degenerative diseases, with 3 different fixation techniques: open posterolateral instrumentation alone (PLI) or in association with lumbar interbody cages (transforaminal lumbar interbody fusion [TLIF] or extreme lateral interbody fusion [XLIF]). Methods We retrospectively reviewed all adult patients affected by single-segment degenerative spondylotic disease who underwent PLI alone or percutaneous posterolateral instrumentation (pPLI) in association with TLIF or XLIF between April 2015 and December 2017 at our institution. Group I included patients who underwent PLI with transpedicular screws and rods, interlaminar bilateral decompression, and posterolateral fusion with autologous bone chips. Group II included patients treated with pPLI + TLIF using a complete unilateral arthrectomy. Group III included patients operated on with minimally invasive retroperitoneal pPLI + XLIF. Results No major complications were reported. The mean segmental loss of lordosis values ranged from 9.17% to 12.28% in Group I, from 6.31%–9.43% in Group II, and from 3.05%–4.71% in Group III. The statistical analysis revealed that pPLI + XLIF maintained a higher segmental lordosis than PLI and pPLI +TLIF in each operated segment ( P P P = 0.12). Conclusions The documented mismatch between the preoperative and postoperative lumbar lordosis might affect the clinical outcome. Its relevance depends on the surgical technique used at the single level. Highlights Lumbar lordosis is fundamental for patients' quality of life, and its restoration or improvement is a major target in spinal surgery. Despite all the efforts, spine surgeons often fail to achieve planned lumbar lordosis. Percutaneous posterolateral instrumentation (pPLI) with extreme lateral interbody fusion (XLIF) is associated with smaller mismatch between intraoperative and postoperative lumbar lordosis.


  • 주제어

    Intraoperative .   Mismatch .   Postoperative .   Segmental lordosis .   Spinal fusion.  

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