To examine monosegmental lordosis after posterior lumbar interbody fusion (PLIF) surgery and relate lordosis to cage size, shape, and placement.
Eighty-three consecutive patients underwent single-level PLIF with paired identical lordotic cages involving a wide decompression and bilateral facetectomies. Cage parameters relating to size (height, lordosis, and length) and placement (expressed as a ratio relative to the length of the inferior vertebral endplate) were recorded. Centre point ratio (CPR) was the distance to the centre of both cages and indicated mean position of both cages. Posterior gap ratio (PGR) was the distance to the most posterior cage and indicated position and cage length indirectly. Relationships between lordosis and cage parameters were explored.
Mean lordosis increased by 5.98° (SD 6.86°). The cages used varied in length from 20 to 27 mm, in lordosis from 10° to 18°, and in anterior cage height from 10 to 17 mm. The mean cage placement as determined by CPR was 0.54 and by PGR was 0.16. The significant correlations were: both CPR and PGR with lordosis gain at surgery (r = 0.597 and 0.537, respectively, p < 0.001 both), cage lordosis with the final lordosis (r = 0.234, p < 0.05), and anterior cage height was negatively correlated with a change in lordosis (r = −0.297, p < 0.01).
Cage size, shape, and position, in addition to surgical technique, determine lordosis during PLIF surgery. Anterior placement with sufficient “clear space” behind the cages is recommended. In addition, cages should be of moderate height and length, so that they act as an effective pivot for lordosis.
Smith JS, Klineberg E, Schwab F et al (2013) Change in classification grade by the SRS-Schwab Adult Spinal Deformity Classification predicts impact on health-related quality of life measures: prospective analysis of operative and nonoperative treatment. Spine 38:1663–1671. doi: 10.1097/BRS.0b013e31829ec563CrossRefPubMed
Vialle R, Dauzac C, Khouri N et al (2007) Sacral and lumbar-pelvic morphology in high-grade spondylolisthesis. Orthopedics 30:642–649 PubMed
Damasceno LHF, Catarin SRG, Campos AD, Defino HLA (2006) Lumbar lordosis: a study of angle values and of vertebral bodies and intervertebral discs role. Acta Ortop Bras 14:193–198 CrossRef
Abbushi A, Cabraja M, Thomale U-W et al (2009) The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation. Eur Spine J 18:1621–1628. doi: 10.1007/s00586-009-1036-3CrossRefPubMedPubMedCentral
Hsieh PC, Koski TR, O’Shaughnessy BA et al (2007) Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine 7:379–386. doi: 10.3171/SPI-07/10/379CrossRefPubMed
Kim J-S, Kang BU, Lee S-H et al (2009) Mini-transforaminal lumbar interbody fusion versus anterior lumbar interbody fusion augmented by percutaneous pedicle screw fixation: a comparison of surgical outcomes in adult low-grade isthmic spondylolisthesis. J Spinal Disord Tech 22:114–121. doi: 10.1097/BSD.0b013e318169bff5CrossRefPubMed
Acosta FL, Liu J, Slimack N et al (2011) Changes in coronal and sagittal plane alignment following minimally invasive direct lateral interbody fusion for the treatment of degenerative lumbar disease in adults: a radiographic study. J Neurosurg Spine 15:92–96. doi: 10.3171/2011.3.SPINE10425CrossRefPubMed
Takahashi H, Suguro T, Yokoyama Y et al (2010) Effect of cage geometry on sagittal alignment after posterior lumbar interbody fusion for degenerative disc disease. J Orthop Surg (Hong Kong) 18:139–142 CrossRef
Evans JD (1996) Straightforward statistics for the behavioral sciences. Brooks/Cole, Pacific Grove
Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates, Mahwah
- Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction
Priyan R. Landham
Angus S. Don
Peter A. Robertson
- Springer Berlin Heidelberg
Neu im Fachgebiet Orthopädie und Unfallchirurgie
e.Med Kampagnen-Visual, Mail Icon II