scholarly journals Proximal Fusion Level Above First Coronal Reverse Vertebrae: An Essential Factor Decreasing the Risk of Adjacent Segment Degeneration in Degenerative Lumbar Scoliosis

2021 ◽  
pp. 219256822199408
Author(s):  
Hui Wang ◽  
Zhuoran Sun ◽  
Longjie Wang ◽  
Da Zou ◽  
Weishi Li
Keyword(s):  
Mechanical Load ◽  
Stable Condition ◽  
Adjacent Segment Degeneration ◽  
Control Group ◽  
Adjacent Segment ◽  
Study Group ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbar Scoliosis ◽  
Fusion Level ◽  
Scoliosis Progression

Study Design: Retrospective radiological analysis. Objective: To explore whether proximal fusion level above first coronal reverse vertebrae (FCRV) could decrease risk of adjacent segment degeneration (ASD) in degenerative lumbar scoliosis (DLS). Methods: One hundred and 16 DLS patients were divided into 2 groups according to occurrence of ASD: study group (ASD positive group) and control group (ASD negative group). FCRV was defined as the first vertebrae that presents opposite orientation of asymmetric Hounsfield unit (HU) ratio from the other vertebrae within major curve. Incidence of ASD was evaluated in subgroups according to location between FCRV and upper instrumented vertebrae (UIV). Results: The fusion level was shorter in study group than that in control group. There were 12 patients presented FCRV 2-level proximal than SV, 32 patients presented FCRV 1-level proximal than SV, 35 patients presented the same vertebra of FCRV with SV, 23 patients presented FCRV 1-level distal than SV, 14 patients presented FCRV 2-level distal than SV. When UIV located above FCRV, no patient presented ASD, while 15.4% patients presented ASD when UIV located on FCRV. In study group, proximal scoliosis progression was detected in 1 patient (3.9%) when UIV located on FCRV, and 17 patients (29.8%) when UIV located below FCRV. Conclusions: Proximal fusion level above FCRV could decrease the risk of ASD in DLS, especially for the proximal scoliosis progression. FCRV represent the transitional point of the mechanical load on coronal plane, and may be within a more stable condition than stable vertebrae measured from radiographs.

Impact of shift to the concave side of the C7-center sacral vertical line on de novo degenerative lumbar scoliosis progression in elderly volunteers

2020 ◽  
Vol 25 (1) ◽  
pp. 82-88
Author(s):  
Hiroki Ushirozako ◽  
Go Yoshida ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
De Novo ◽  
Concave Side ◽  
Vertical Line ◽  
Degenerative Lumbar Scoliosis ◽  
Lumbar Scoliosis ◽  
Scoliosis Progression

scholarly journals Predicting factors of adjacent segment degeneration after long-segment spinal fusion: spinopelvic parameters analysis

2020 ◽  
Author(s):  
Ping-Yeh Chiu ◽  
Fu-Cheng Kao ◽  
Wen-Jer Chen ◽  
Chia-Wei Yu ◽  
Chi-Chien Niu ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Control Group ◽  
Sacral Slope ◽  
Adjacent Segment ◽  
Spinopelvic Parameters ◽  
Significant Difference ◽  
Adjacent Disc

Abstract Background We investigated whether spinopelvic parameters are important prognostic factors causing adjacent segment degeneration (ASD) after long instrumented spinal fusion for degenerative spinal disease. Methods This uncontrolled, randomized, single arm retrospective study included patients who underwent long instrumented lumbar fusion (fusion levels≥ 4) in the past 5 years with follow-up for at least 2 years. The inclusion criteria included adult patients (≥40 years of age) with a diagnosis of spinal degeneration who underwent instrumented corrective surgery. The exclusion criteria included preexisting adjacent disc degeneration, combined anterior reconstructive surgery, and distal ASD. Clinical and operative characters were evaluated. Angle of lumbar lordosis (LLA), sacral slope (SSA), pelvic tilt (PTA) and pelvic incidence (PIA) were compared preoperatively, postoperatively and at the final follow-up. Results From 2009 to 2014, 60 patients (30 ASD and 30 non-ASD) were enrolled. The average age was 66.82 ± 7.48 years for the study group and 67.97 ± 7.81 years for the control group. There was no statistically significant difference in clinical and operative characteristics. Among all spinopelvic parameters, only pre-, post-operative and final follow-up PIA in ASD group (53.9±10.4ﾟ, 54.6±14.0ﾟ, 54.3±14.1ﾟ) and non-ASD group (60.3±13.0ﾟ, 61.8±11.3ﾟ, 62.5±11.2ﾟ) showed statistically significant differences ( p <0.05). Conclusion This study confirms that preoperative, postoperative and final follow-up PIA is a significant factor contributing to the development of ASD after long instrumented spinal fusion.

scholarly journals Selection of proximal fusion level for adult degenerative lumbar scoliosis

2012 ◽  
Vol 22 (2) ◽  
pp. 394-401 ◽  
Author(s):  
Kyu-Jung Cho ◽  
Se-Il Suk ◽  
Seung-Rim Park ◽  
Jin-Hyok Kim ◽  
Jae-Hoon Jung
Keyword(s):  
Degenerative Lumbar Scoliosis ◽  
Lumbar Scoliosis ◽  
Fusion Level ◽  
Selection Of

scholarly journals The influence of spinopelvic parameters on adjacent-segment degeneration after short spinal fusion for degenerative spondylolisthesis

2018 ◽  
Vol 29 (4) ◽  
pp. 407-413 ◽  
Author(s):  
Ming-Kai Hsieh ◽  
Fu-Cheng Kao ◽  
Wen-Jer Chen ◽  
I-Jung Chen ◽  
Sheng-Fen Wang
Keyword(s):  
Spinal Fusion ◽  
Degenerative Spondylolisthesis ◽  
Slope Angle ◽  
Adjacent Segment Degeneration ◽  
Control Group ◽  
Adjacent Segment ◽  
Spinopelvic Parameters ◽  
Lumbosacral Fusion ◽  
Single Level ◽  
Matching Criteria

OBJECTIVESpinopelvic parameters, such as the pelvic incidence (PI) angle, sacral slope angle, and pelvic tilt angle, are important anatomical indices for determining the sagittal curvature of the spine and the individual variability of the lumbar lordosis (LL) curve. The aim of this study was to investigate the influence of spinopelvic parameters and LL on adjacent-segment degeneration (ASD) after short lumbar and lumbosacral fusion for single-level degenerative spondylolisthesis.METHODSThe authors retrospectively reviewed the records of all short lumbar and lumbosacral fusion surgeries performed between August 2003 and July 2010 for single-level degenerative spondylolisthesis in their orthopedic department.RESULTSA total of 30 patients (21 women and 9 men, mean age 64 years) with ASD after lower lumbar or lumbosacral fusion surgery comprised the study group. Thirty matched patients (21 women and 9 men, mean age 63 years) without ASD comprised the control group, according to the following matching criteria: same diagnosis on admission, similar pathologic level (≤ 1 level difference), similar sex, and age. The average follow-up was 6.8 years (range 5–8 years). The spinopelvic parameters had no significant influence on ASD after short spinal fusion.CONCLUSIONSNeither the spinopelvic parameters nor a mismatch of PI and LL were significant factors responsible for ASD after short spinal fusion due to single-level degenerative spondylolisthesis.

184. Selection of Proximal Fusion Level in Adult Lumbar Segemnetal Instrumented Fusion to L5 or S1 for Degenerative Lumbar Scoliosis

2009 ◽  
Vol 9 (10) ◽  
pp. 96S-97S
Author(s):  
Yongjung Kim ◽  
Oheneba Boachie-Adjei ◽  
Keith Bridwell ◽  
Lawrence Lenke ◽  
Youngbae Kim ◽  
...  
Keyword(s):  
Degenerative Lumbar Scoliosis ◽  
Instrumented Fusion ◽  
Lumbar Scoliosis ◽  
Fusion Level ◽  
Selection Of

scholarly journals Predicting factors of adjacent segment degeneration after long-segment spinal fusion: spinopelvic parameters analysis

2019 ◽  
Author(s):  
Ping-Yeh Chiu ◽  
Fu-Cheng Kao ◽  
Wen-Jer Chen ◽  
Chia-Wei Yu ◽  
Chi-Chien Niu ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Slope Angle ◽  
Adjacent Segment Degeneration ◽  
Control Group ◽  
Adjacent Segment ◽  
Spinopelvic Parameters ◽  
Significant Difference ◽  
Adjacent Disc

Abstract Purpose We investigated whether spinopelvic parameters are important prognostic factors for adjacent segment degeneration after long instrumented spinal fusion for degenerative spinal disease. Methods This uncontrolled, randomized, single arm retrospective study included patients who underwent long instrumented lumbar fusion (fusion levels≥ 4) in the past 5 years with follow-up for at least 2 years. The inclusion criteria included adult patients (≥40 years of age) with a diagnosis of spinal degeneration who underwent instrumented corrective surgery. The exclusion criteria included preexisting adjacent disc degeneration, combined anterior reconstructive surgery, and distal ASD. Clinical and operative characters were evaluated. Lumbar lordotic angle (LLA), sacral slope angle (SSA), pelvic tilt angle (PTA) and pelvic incidence angle (PIA) were compared preoperatively, postoperatively and at the final follow-up. Results From 2009 to 2014, 60 patients (30 ASD and 30 non-ASD patients) were enrolled. The average age was 66.82 ± 7.48 years for the study group and 67.97 ± 7.81 years for the control group. There was no statistically significant difference in clinical and operative characteristics. Among all spinopelvic parameters, only pre-, post-operative and final follow-up PIA in ASD group (53.9±10.4ﾟ, 54.6±14.0ﾟ, 54.3±14.1ﾟ) and non-ASD group (60.3±13.0ﾟ, 61.8±11.3ﾟ, 62.5±11.2ﾟ) showed statistically significant differences (p<0.05). Conclusion This study confirms that preoperative, postoperative and final follow-up PIA is a significant factor contributing to the development of adjacent segment degeneration after long instrumented spinal fusion.

Diffusion tensor tractography of the lumbar nerves before a direct lateral transpsoas approach to treat degenerative lumbar scoliosis

2019 ◽  
Vol 30 (4) ◽  
pp. 461-469 ◽  
Author(s):  
Yawara Eguchi ◽  
Masaki Norimoto ◽  
Munetaka Suzuki ◽  
Ryota Haga ◽  
Hajime Yamanaka ◽  
...  
Keyword(s):  
Diffusion Tensor ◽  
Concave Side ◽  
Control Group ◽  
Degenerative Lumbar Scoliosis ◽  
Convex Side ◽  
Lumbar Scoliosis ◽  
Transpsoas Approach ◽  
Nerve Tracts ◽  
Psoas Major ◽  
The Relationship

OBJECTIVEThe purpose of this study was to determine the relationship between vertebral bodies, psoas major morphology, and the course of lumbar nerve tracts using diffusion tensor imaging (DTI) before lateral interbody fusion (LIF) to treat spinal deformities.METHODSDTI findings in a group of 12 patients (all women, mean age 74.3 years) with degenerative lumbar scoliosis (DLS) were compared with those obtained in a matched control group of 10 patients (all women, mean age 69.8 years) with low-back pain but without scoliosis. A T2-weighted sagittal view was fused to tractography from L3 to L5 and separated into 6 zones (zone A, zones 1–4, and zone P) comprising equal quarters of the anteroposterior diameters, and anterior and posterior to the vertebral body, to determine the distribution of nerves at various intervertebral levels (L3–4, L4–5, and L5–S1). To determine psoas morphology, the authors examined images for a rising psoas sign at the level of L4–5, and the ratio of the anteroposterior diameter (AP) to the lateral diameter (lat), or AP/lat ratio, was calculated. They assessed the relationship between apical vertebrae, psoas major morphology, and the course of nerve tracts.RESULTSAlthough only 30% of patients in the control group showed a rising psoas sign, it was present in 100% of those in the DLS group. The psoas major was significantly extended on the concave side (AP/lat ratio: 2.1 concave side, 1.2 convex side). In 75% of patients in the DLS group, the apex of the curve was at L2 or higher (upper apex) and the psoas major was extended on the concave side. In the remaining 25%, the apex was at L3 or lower (lower apex) and the psoas major was extended on the convex side. Significant anterior shifts of lumbar nerves compared with controls were noted at each intervertebral level in patients with DLS. Nerves on the extended side of the psoas major were significantly shifted anteriorly. Nerve pathways on the convex side of the scoliotic curve were shifted posteriorly.CONCLUSIONSA significant anterior shift of lumbar nerves was noted at all intervertebral levels in patients with DLS in comparison with findings in controls. On the convex side, the nerves showed a posterior shift. In LIF, a convex approach is relatively safer than an approach from the concave side. Lumbar nerve course tracking with DTI is useful for assessing patients with DLS before LIF.

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