Individual Lordotic Cages Implantation and Radiographic Evaluation of Segmental and Lumbar Lordosis Correction for Patients with Adult Degenerative Scoliosis

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Abstract

Relevance. The development of minimally invasive surgery has led to the development of new methods for surgical treatment of the spine. Conventional surgical technique, such as vertebrotomy is accompanied by a several number of disadvantages (high blood loss, prolonged hospital stay, long intraoperative time, postoperative neurological deficit). An alternative to improve sagittal balance in the spine is to use custom-made hyperlordotic cages, which can also be used for indirect decompression of neural structures.

The objective is to compare the degree of segmental and total lumbar lordosis using hyperlordotic cages through ALIF and TLIF with posterior instrumentation.

Materials and Methods. A single-center retrospective cohort study using 96 patients treated from 2018 to 2019 about degenerative spinal deformities. Comparison of two groups: group 1 (A) consisted of 30 patients who were held anterior spinal fusion with individual lordotic cages from minimally invasive anterior approach (MISS ALIF) without posterior fixation. Group 2 (B) consisted of 33 patients whom were performed spinal fusion from the posterior approach (TLIF) with Smith-Peterson Osteotomy (SPO) and transpedicular fixation. Measuring segmental and lumbar lordosis, teleradiographs were used in a standing position. For an accurate assessment, the non-commercial available Surgimap software, © Nemaris, was used.

Results. Segmental lordosis were superior to preoperative ones. In the intergroup comparison, the ALIF group showed an excellent increase in the enlarged lordosis segment (L3-L4 in 8 degrees; p = 0.0005, L4-L5 in 7 degrees; p = 0.0002, L5-S1 in 7 degrees; p = 0.0001). When conducting an intergroup comparison of total lumbar lordosis in the preoperative period, there was a statistically significant difference between them (p = 0.0043). At the same time, a greater degree of correction of lordosis is shown in ALIF compared to TLIF group (29,1 in comparison with 22,5; p = 0.00005).

Conclusion. The results of this study confirm that the using of custom-made lordotic cages can significantly increase segmental and total lumbar lordosis for patients with degenerative scoliosis in adults.

About the authors

A. A. Denisov

Vreden National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: denisov1993@gmail.com

Anton A. Denisov — PhD Student

St. Petersburg

Russian Federation

D. A. Ptashnikov

Vreden National Medical Research Center of Traumatology and Orthopedics;
Mechnikov North-Western State Medical University

Email: fake@neicon.ru

Dmitry A. Ptashnikov — Dr. Sci. (Med.), Professor, the Head of Scientific Department of Neuroorthopedics and Bone Tumors; the Head of Traumatology and Orthopedics Department

St. Petersburg

Russian Federation

D. A. Mikhaylov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Dmitry A. Mikhaylov — Cand. Sci. (Med.), Orthopedic Surgeon

St. Petersburg

Russian Federation

S. V. Masevnin

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Sergey V. Masevnin — Cand. Sci. (Med.), Orthopedic Surgeon

St. Petersburg

Russian Federation

O. A. Smekalenkov

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Oleg A. Smekalenkov — Cand. Sci. (Med.), Orthopedic Surgeon

St. Petersburg

Russian Federation

N. S. Zaborovskii

Vreden National Medical Research Center of Traumatology and Orthopedics

Email: fake@neicon.ru

Nikita S. Zaborovski — Cand. Sci. (Med.), Orthopedic Surgeon

St. Petersburg

Russian Federation

References

  1. Лебедев В.Б., Епифанов Д.С., Костенко Г.В., Гходивала Т.С., Нурмухаметов Р.М., Педяш Н.В., Зуев А.А. Мини-инвазивная реконструкция позвоночного канала при дегенеративном поясничном стенозе. Хирургия позвоночника. 2017;14(3):67-73. doi: 10.14531/ss2017.3.67-73.
  2. Dangelmajer S., Zadnik P.L., Rodriguez S.T., Gokaslan Z.L., Sciubba D.M. Minimally invasive spine surgery for adult degenerative lumbar scoliosis. Neurosurg Focus. 2014;36(5):E7. doi: 10.3171/2014.3.FOCUS144.
  3. Козлов Д.М., Крутько А.В., Колотов Е.Б., Ахметьянов Ш.А. Отдаленные результаты хирургического лечения дегенеративных заболеваний поясничного отдела позвоночника у пациентов старше 60 лет. Вопросы нейрохирургии им. Н.Н. Бурденко. 2011;75(3):57-61.
  4. Михайлов Д.А., Пташников Д.А., Масевнин С.В., Смекаленков О.А., Заборовский Н.С., Лапаева О.А., Мураби З. Pезультаты лечения пациентов пожилого и старческого возраста с дегенеративными деформациями и нестабильностью позвоночника. Травматология и ортопедия России. 2017;23(2):15-26. doi: 10.21823/2311-2905-2017-23-2-15-26.
  5. DeWald C.J., Stanley T. Instrumentation-related complications of multilevel fusions for adult spinal deformity patients over age 65: Surgical considerations and treatment options in patients with poor bone quality. Spine (Phila Pa 1976). 2006;31(19 Suppl):S144-S151. doi: 10.1097/01.brs.0000236893.65878.39.
  6. Wang H., Zhang Z., Qiu G., Zhang J., Shen J. Risk factors of perioperative complications for posterior spinal fusion in degenerative scoliosis patients: a retrospective study. BMC Musculoskelet Disord. 2018;19(1):242. doi: 10.1186/s12891-018-2148-x.
  7. Пелеганчук А.В., Базлов В.А., Крутько А.В. Декомпрессивно-стабилизирующие оперативные вмешательства с использованием индивидуальных кейджей, изготовленных методом 3D-печати. Хирургия позвоночника. 2018;15(1):65-70. doi: 10.14531/ss2018.1.65-70.
  8. Phillips F.M., Isaacs R.E., Rodgers W.B., Khajavi K., Tohmeh A.G., Deviren V. et al. Adult degenerative scoliosis treated with XLIF clinical and radiographical results of a prospective multicenter study with 24-month follow-up. Spine (Phila Pa 1976). 2013;38(21):1853-1861. doi: 10.1097/BRS.0b013e3182a43f0b.
  9. Odeh K., Rosinski A., Nguyen J., Modak A., Leasure J., Siebert S., Kondrashov D. Anterior Lumbar Interbody Fusion May Provide Superior Decompression of the Foraminal Space Compared with Direct Foraminotomy: Biomechanical Cadaveric Study. World Neurosurg. 2020;135:e71-e76. doi: 10.1016/j.wneu.2019.10.139.
  10. Wang G., Hu J., Liu X., Cao Y. Surgical treatments for degenerative lumbar scoliosis: a meta analysis. Eur Spine J. 2015;24(8):1792-1799. doi: 10.1007/s00586-015-3942-x.
  11. Schwab F., Ungar B., Blondel B. et al. Scoliosis Research Society–Schwab Adult Spinal Deformity Classification. Spine (Phila Pa 1976). 2012;37(12):1077-1082. doi: 10.1097/BRS.0b013e31823e15e2
  12. Griffith J.F., Wang Y.X.J., Antonio G.E. Choi K.C., Yu A., Ahuja A.T. et al. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2007;32(24). doi: 10.1097/BRS.0b013e31815a59a0
  13. Elowitz E., Yanni D., Chwajol M., Starke R.M., Perin N.I. Evaluation of indirect decompression of the lumbar spinal canal following minimally invasive lateral transpsoas interbody fusion: radiographic and outcome analysis. Minim Invasive Neurosurg. 2011;54(5-6): 201-206. doi: 10.1055/s-0031-1286334.
  14. Rahn K.A., Shugart R.M., Wylie M.W., Reddy K.K., Morgan J.A. The effect of lordosis, disc height change, subsidence, and transitional segment on stand-alone anterior lumbar interbody fusion using a nontapered threaded device. Am J Orthop (Belle Mead NJ). 2010;39(12):E124-129.
  15. Li J., Dumonski M.L., Liu Q., Lipman A., Hong J., Yang N. et al. A multicenter study to evaluate the safety and efficacy of a stand-alone anterior carbon I/F Cage for anterior lumbar interbody fusion: twoyear results from a Food and Drug Administration investigational device exemption clinical trial. Spine (Phila Pa 1976). 2010;35(26):1564-1570. doi: 10.1097/BRS.0b013e3181ef5c14.
  16. Zelle B., Konig F., Enderle A., Bertagnoli R., Dorner J. Circumferential fusion of the lumbar and lumbosacral spine using a carbon fiber ALIF cage implant versus autogenous bone graft: a comparative study. J Spinal Disord Tech. 2002;15(5):369-376. doi: 10.1097/00024720-200210000-00005.
  17. Strube P., Hoff E., Hartwig T., Perka C.F., Gross C., Putzier M. Stand-alone anterior versus anteroposterior lumbar interbody single-level fusion after a mean follow-up of 41 months. J Spinal Disord Tech. 2012. 25(7): 362-369. doi: 10.1097/BSD.0b013e3182263d91.
  18. Barrey C., Perrin G., Michel F., Vital J.M., Obeid I. Pedicle subtraction osteotomy in the lumbar spine: indications, technical aspects, results and complications. Eur J Orthop Surg Traumatol. 2014; 24 Suppl 1:S21-30. doi: 10.1007/s00590-014-1470-8.
  19. Manwaring J.C., Bach K., Ahmadian A.A., Deukmedjian A.R., Smith D.A., Uribe J.S. Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study. J Neurosurg Spine. 2014;20(5):515-522. doi: 10.3171/2014.2.SPINE1347.
  20. Cho K.J., Bridwell K.H., Lenke L.G., Berra A., Baldus C. Comparison of Smith-Petersen Versus Pedicle Subtraction Osteotomy for the Correction of Fixed Sagittal Imbalance. Spine (Phila Pa 1976). 2005;30(18): 2030-2037. doi: 10.1097/01.brs.0000179085.92998.ee.
  21. Liu H., Yang C., Zheng Z., Ding W., Wang J., Wang H., Li S. Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and metaanalysis. Spine (Phila Pa 1976). 2015;40(8):570-579. doi: 10.1097/BRS.0000000000000815.
  22. Anand N., Cohen R.B., Cohen J., Kahndehroo B., Kahwaty S., Baron E. The Influence of Lordotic cages on creating Sagittal Balance in the CMIS treatment of Adult Spinal Deformity. Int J Spine Surg. 2017;11:23. doi: 10.14444/4023.
  23. Marchi L., Oliveira L., Amaral R, Castro C., Coutinho T., Coutinho E., Pimenta L. Anterior elongation as a minimally invasive alternative for sagittal imbalance - a case series. HSS J. 2012;8(2):122-127. doi: 10.1007/s11420-011-9226-z.
  24. Ozgur B.M., Aryan H.E., Pimenta L., Taylor W.R. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006;6(4):435-443. doi: 10.1016/j.spinee.2005.08.012.
  25. Saville P.A., Kadam A.B., Smith H.E., Arlet V. Anterior hyperlordotic cages: early experience and radiographic results. J Neurosurg Spine. 2016;25(6):713-719. doi: 10.3171/2016.4.spine151206.
  26. Kapustka B., Kiwic G., Chodakowski P., Miodoński J.P., Wysokiński T., Łączyński M. et al. Anterior lumbar interbody fusion (ALIF): biometrical results and own experiences. Neurosurg Rev. 2020;43(2):687-693. doi: 10.1007/s10143-019-01108-1.
  27. Cho K.J., Suk S.I., Park S.R., Kim J.H., Kang S.B., Kim H.S., Oh S.J. Risk factors of sagittal decompensation after long posterior instrumentation and fusion for degenerative lumbar scoliosis. Spine (Phila Pa 1976). 2010;35(17): 1595-1601. doi: 10.1097/BRS.0b013e3181bdad89.

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