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Lumbar Sagittal Balance Influences the Clinical Outcome After Decompression and Posterolateral Spinal Fusion for Degenerative Lumbar Spondylolisthesis

Kawakami, Mamoru, MD,*; Tamaki, Tetsuya, MD,*; Ando, Muneharu, MD,*; Yamada, Hiroshi, MD,*; Hashizume, Hiroshi, MD,*; Yoshida, Munehito, MD

Clinical Case Study
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Study Design.  This study was designed to assess both lumbar sagittal balance and clinical outcomes of decompression and posterolateral fusion for degenerative lumbar spondylolisthesis. As an index for the radiologic evaluation of sagittal alignment, the L1 axis S1 distance was used (i.e., the horizontal distance from the plumbline of the center in the L1 to the back corner of the S1).

Objective.  To determine whether lumbar sagittal balance affected the clinical outcome after posterolateral fusion.

Summary of Background Data.  Little is known about whether the sagittal vertical axis influences clinical outcomes in cases of degenerative lumbar spondylolisthesis.

Methods.  A retrospective review of 47 patients (15 men and 32 women), ranging in age from 41 to 79 years, was conducted. The mean follow-up period was 3.6 years. Relations among outcomes including the visual analog pain scale, recovery rate, L1 axis S1 distance, slippage, and lumbar lordosis were evaluated.

Results.  Recovery rates were 44% and 62% in patients whose preoperative L1 axis S1 distance, respectively, was more than 35 mm (Group A, n = 16) and less than 35 mm (Group B, n = 31) (P < 0.05). Follow-up assessment found a positive correlation between only lordosis and recovery rate. Severe low back pain and lower recovery rate were observed in patients with in situ fusion in Group A (n = 9), as compared with patients with reduced slippage in Group A (n = 7) and patients in Group B.

Conclusions.  Both preoperative L1 axis S1 distance and lordosis at follow-up assessment affected surgical outcome. Reduction of slippage may improve clinical outcomes of posterolateral fusion for degenerative lumbar spondylolisthesis with an L1 axis S1 distance more than 35 mm.

From the *Department of Orthopaedic Surgery, and the

†Department of Physical Medicine and Rehabilitation, Wakayama Medical University, Wakayama City, Wakayama, Japan.

Acknowledgment date: November 10, 2000.

First revision date: April 23, 2001.

Acceptance date: June 4, 2001.

Device status category: 1.

Conflict of interest category: 14.

Address reprint requests to

Mamoru Kawakami, MD, PhD

Department of Orthopaedic Surgery

Wakayama Medical University

811-1, Kimiidera, Wakayama City

Wakayama 641-0012, Japan

E-mail: kawakami@wakayama-med.ac.jp

© 2002 Lippincott Williams & Wilkins, Inc.