Distal Lumbar Lordosis is Associated With Reoperation for Adjacent Segment Disease After Lumbar Fusion for Degenerative Conditions. Global spine journal STUDY DESIGN:A single centre retrospective review. OBJECTIVE:Recent studies have suggested that distal lordosis (L4-S1, DL) remains constant across all pelvic incidence (PI) subgroups, whilst proximal lordosis (L1-L4, PL) varies. We sought to investigate the impact of post-operative DL on adjacent segment disease (ASD) requiring reoperation in patients undergoing lumbar fusion for degenerative conditions. METHODS:Patients undergoing 1-3 level lumbar fusion with the two senior authors between 2007-16 were included. Demographic and radiographic data were recorded. Univariate, multivariate binary logistic regression, and Kaplan Meier survivorship analyses were performed. RESULTS:335 patients were included in the final analysis. Most had single (67%) or two (31%) level fusions. The mean follow-up was 64-month. Fifty-seven patients (17%) underwent reoperation for ASD at an average of 78-month post-operatively (R group). The R group had a significantly lower mean post-operative DL (27.3 vs 31.1 deg, < .001) and mean PI (55.5 vs 59.2 deg, < .05). On univariate analysis, patients with a post-operative DL of <35 deg had higher odds of reoperation for ASD than those with a post-operative DL of ≥35 deg (OR 2.7, = .016). In the multivariate model, post-operative DL, low/average PI, and spondylolisthesis were all significantly associated with reoperation for ASD. CONCLUSION:This study provides preliminary support to an association between post-operative distal lumbar lordosis and risk of reoperation for ASD in patients undergoing fusions for degenerative conditions. Further multicentre prospective study is needed to independently confirm this association and identify the impact of restoration of physiological distal lumbar lordosis on long term patient outcomes. 10.1177/21925682241262704

[Effects of different pelvic incidence minus lumbar lordosis mismatch after long posterior instrumentation and fusion for adult degenerative scoliosis]. Sun X Y,Hai Y,Zhang X N Zhonghua wai ke za zhi [Chinese journal of surgery] To evaluate the influence of PI-LL (pelvic incidence minus lumbar lordosis mismatch) on scoliosis correction, living quality and internal fixation related complications for adult degenerative scoliosis (ASD) after long posterior instrumentation and fusion. A total of 79 patients with ADS underwent long posterior instrumentation and fusion in the Department of Orthopedics at Beijing Chao Yang Hospital from January 2010 to January 2014 were retrospectively reviewed.There were 21 males and 58 females aging from 55 to 72 years with the mean age (63.4±4.8)years. The patients were divided into three groups according to immediately postoperative PI-LL: PI-LL<10°, 10°≤PI-LL≤20°, PI-LL>20°.Compare the Cobb's angles, PI-LL, Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and Lumbar Stiffness Disability Index (LSDI). Measurement data were compared via test and ANOVA, enumeration data were compared via Kruskal-Wallis test, noncontiguous data was performed by χ(2) test. Univariate linear regression equation was performed to investigate the relative influences of postoperative PI-LL on postoperative radiographic parameters and clinical outcome. All the operations were successful without intraoperative complications. The operation time was 145-310 minutes (235.3±42.0) minutes, the intraoperative blood loss was 300-5 300 ml (1 021±787) ml, the duration of hospital was 12-18 d (14.5±1.3) d. A total of 4 to 10 (7.0±1.1) vertebra levels were fused. Compared to preoperative, the Cobb's angle of scoliosis ((4.2±1.8)° . (20.1±2.7)°), PI-LL ((16.1±8.6)° . (36.0±4.3)°), JOA (3.0±1.3 . 5.5±1.2), ODI (24.4±8.1 . 62.9±2.7), VAS (3.0±1.0 . 6.8±1.3) were significantly decreased postoperative (=18.539~53.826, <0.01). Compared to preoperative, postoperative Cobb's angle of scoliosis ((4.1±2.7)° . (19.5±2.7)°, (4.0±1.4)° . (20.2±2.4)°, (4.7±0.9)° . (20.6±3.0)°) (=21.148-45.355, <0.01) and PI-LL ((5.2±2.8)° . (35.8±4.9)°, (17.9±2.9)° . (37.2±3.9)°, (25.8±2.7)° . (34.5±4.0)°) (=7.227-38.250, <0.01) were significantly reduced postoperative in PI-LL<10° group, 10°≤PI-LL≤20° group and PI-LL>20° group. Compared to preoperative, ODI (27.7±4.9 . 63.3±2.6, 17.7±5.9 . 63.1±2.8, 30.6±6.5 . 62.3±2.5) (=21.218~50.858, <0.01), JOA (2.8±1.2 . 5.2±1.2, 3.3±1.1 . 5.7±1.1, 2.8±1.7 . 5.7±1.2) (=9.042-16.025, <0.01) and VAS (2.9±1.2 .7.0±1.3, 3.3±0.9 .7.0±1.4, 2.9±0.8 . 6.3±1.2) (=16.073-22.214, <0.01) were all significantly reduced at last follow-up. There were statistic differences in ODI and LSDI (=38.477, <0.01; =37.063, <0.01) at the last follow-up among the three groups. There was a negative correlation in PI-LL and LSDI according to linear regression (=-5.838, <0.01) in the last follow-up. All the patients were followed up, the follow-up duration were 2 to 5 years with the mean (3.1±0.7) years. The internal fixation failure related complications in 3 years included proximal junctional kyphosis (PJK) in 19 cases, internal fixation loosening in 6 cases. Eight patients received reoperation for severe local pain and low extremity symptoms. PJK occurrences were significantly different among PI-LL<10° group, 10°≤PI-LL≤20° group and PI-LL>20° group. The PI-LL between 10° and 20° may be the best choice in ADS patients after long posterior instrumentation and fusion for its better clinical outcome and less proximal junctional kyphosis (PJK). The overcorrection of LL may lead to more serious postoperative lumbar stiffness. 10.3760/cma.j.issn.0529-5815.2017.06.007

Living with a C2-Sacrum Spinal Fusion: Surgical Outcomes and Quality of Life in Patients Fused from C2 to the Sacrum. Global spine journal STUDY DESIGN:Single center, retrospective cohort study. OBJECTIVES:Little is known about the surgical outcomes and quality of life in patients with C2-sacrum posterior spinal fusion (PSF). Though it is thought to be a "final" construct, it remains unknown how patients fare postoperatively. We sought to evaluate the surgical outcomes and quality of life of patients after C2-sacrum PSF. METHODS:Consecutive patients undergoing C2-Sacrum PSF from 2015-2020 by 4 surgeons at a single institution were included. The study time period for each patient began after their index operation that led to the C2-sacrum fusion. Dates of surgery, complications, reoperations, patient reported outcomes (PROs) including EuroQol 5 Dimensions (EQ-5D), Oswestry Disability Index (ODI), Scoliosis Research Society (SRS) questionnaires, and activities of daily living (ADL) questions were collected and analyzed. Descriptive statistics, paired t-tests, student t-tests, and linear regression were used. RESULTS:Of the 23 patients who underwent C2-sacrum PSF, 6 patients (26%) required a total of 10 reoperations after a mean of 1.5 years (range 0-4 years) after C2-sacrum PSF. Five reoperations were for mechanical failure; 3 for wound complications/infection; and 2 for instrumentation and spinous process prominence. PROs were collected on 18 patients with mean follow-up of 2.4 years (range .5-4.5) after their C2-sacrum PSF. At 6-months, both SRS-22 and ODI scores improved significantly after C2-sacrum PSF (SRS: 57.5 to 76.3, = .0014; ODI: 47.0 to 31.7, = .013). Similarly, at a mean 2.4 years postoperatively, mean ODI improved significantly (47.0 to 30.4, = .0032). Six patients (33%) had minimal symptoms (ODI <20). The median postoperative EQ-5D score was .74 (range .19 to 1.0), which compares favorably to patients with hip/knee osteoarthritis (EQ-5D .63) and diabetes mellitus (DM) (EQ-5D .69) and hypertension (HTN). In terms of activities of daily living (ADL), 10 patients (56%) exercised regularly-a mean 4.5 days/week. 11 (61%) could do light aerobic activity (e.g. stationary bike). 10 (55%) were able to play with children/grandchildren as desired. Eight patients (44%) hiked, and 2 (11%) drove independently. 11 (61%) could tolerate short air-travel comfortably. Of the 17 patients who could toilet and perform basic hygiene preoperatively, 16 (94%) were able to do so postoperatively. CONCLUSION:Though C2-sacrum PSF is thought to be a "final" construct, approximately 1 in 4 patients require subsequent operations. However, C2-sacrum PSF patients had a significant improvement in SRS and ODI scores by 6 months postop. Over 60% of patients were regularly performing light aerobic activity 2 years after their C2-sacrum PSF. EQ-5D suggests that this population fares better than those with degenerative hip/knee arthritis and similarly to those with common chronic conditions like DM and HTN. 10.1177/21925682221149389

[Advance in evaluation of lumbar function after long fixation of degenerative scoliosis]. Zhang X L,Yuan L,Zeng Y,Mai S Zhonghua wai ke za zhi [Chinese journal of surgery] With the aging of the population, the incidence of degenerative lumbar scoliosis has increased year by year. Long-segment orthopedic fixation surgery is an important method for the treatment of severe degenerative lumbar scoliosis. Currently, the evaluation of postoperative results is mainly based on the degree of relief of postoperative clinical symptoms, as well as the improvement of imaging deformity and balance. The studies show that although surgery has high difficulty and risk, most patients can benefit from surgery. Besides, it is reported that long-segment fixation can alleviate the symptoms of pain and improve the quality of life. However, it also decreases the local activity of the lumbar spine, leading to stiffness of lumbar, which may affect the activities of daily living (ADL) partly. Lumbar Stiffness Disability Index (LSDI) is a scale for evaluating the impact of lumbar spine stiffness on ADL. The scale has certain limitations and needs to be applied to Chinese people on the basis of optimization. In this paper, the researches of lumbar spine function evaluation after degenerative lumbar scoliosis and long segmental orthopedic fixation and the clinical use of LSDI are briefly reviewed. 10.3760/cma.j.issn.0529-5815.2019.05.016