Effects of preoperative sagittal spinal imbalance on pain after lateral lumbar interbody fusion

• Published in: Scientific reports Vol. 12; no. 1; p. 3001
• Main Authors: Hiyama, Akihiko, Katoh, Hiroyuki, Sakai, Daisuke, Sato, Masato, Watanabe, Masahiko
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 22.02.2022; Nature Publishing Group UK; Nature Portfolio
• Subjects: Aged; Back pain; Bone Malalignment - complications; Bone Malalignment - surgery; Degenerative diseases; Demography; Female; Humans; Leg; Low back pain; Low Back Pain - etiology; Low Back Pain - surgery; Lumbar Vertebrae - surgery; Male; Pain, Postoperative - etiology; Pain, Postoperative - surgery; Patients; Pedicle Screws; Preoperative Period; Quality of Life; Spinal Fusion - adverse effects; Spinal Fusion - methods; Surgery; Treatment Outcome
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-06389-z

Sagittal misalignment has been associated with negative quality of life (QOL). However, there is no report on whether differences in preoperative sagittal misalignment in patients with lumbar degenerative diseases affect postoperative results after lateral lumbar interbody fusion (LLIF). We investigated whether preoperative sagittal alignment influences the correction of alignment after surgery and whether the preoperative sagittal alignment affects the rating of low back pain, leg pain, and leg numbness. The subjects were 81 patients (48 male, 33 females, average age at surgery 70.2 years) who underwent anterior-posterior combined surgery with LLIF and percutaneous pedicle screws from May 2018 to July 2020. Cluster analysis was performed using the preoperative sagittal vertical axis (SVA) value, and patients were classified into two groups (group 1; n = 30, SVA = 129.0 ± 53.4 mm, group 2; n = 51, SVA = 30.8 ± 23.5 mm). Baseline demographics and treatment data were compared between groups. Sagittal and pelvic parameters and pain scores, such as low back pain, leg pain, and leg numbness, were also compared. Operative time, blood loss, and length of hospital stay did not differ significantly between groups. The changes (Δ) in SVA and lumbar lordosis (LL) for all patients from before to after surgery were not significant (ΔSVA; p = 0.218, ΔLL; p = 0.189, respectively). The SVA, LL, and PI - LL changed significantly after the surgery in group 1, but no marked improvement in sagittal imbalance was obtained after LLIF surgery. The improvement in each pain score from before to after the surgery did not differ significantly between groups. LLIF surgery has a limited chance of recovering sagittal imbalance. However, postoperative low back pain, leg pain, and leg numbness may be improved by LLIF surgery, regardless of the preoperative sagittal alignment.