PMID- 35837437
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 0974-8237 (Print)
IS  - 0976-9285 (Electronic)
IS  - 0974-8237 (Linking)
VI  - 13
IP  - 2
DP  - 2022 Apr-Jun
TI  - Does change in focal lordosis after spinal fusion affect clinical outcomes in 
      degenerative spondylolisthesis?
PG  - 127-139
LID - 10.4103/jcvjs.jcvjs_144_21 [doi]
AB  - STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The objective of this study 
      is to determine the effect of focal lordosis and global alignment and proportion 
      (GAP) scores on patient reported outcome measures (PROMs) after posterior lumbar 
      fusion for patients with 1- or 2-level lumbar degenerative spondylolisthesis 
      (DS). SUMMARY OF BACKGROUND DATA: In patients with DS, improvements in 
      spinopelvic parameters are believed to improve clinical outcomes. However, the 
      effect of changing focal lordosis in patients with 1-or 2-level degenerative 
      lumbar spondylolisthesis is unclear. MATERIALS AND METHODS: Postoperative 
      spinopelvic parameters and perioperative focal lordosis changes were measured for 
      162 patients at a single academic center from January 2013 to December 2017. 
      Patients were divided into three groups: >2 degrees  (lordotic group), between 2 degrees  and -2 degrees  
      (neutral group), and -2 degrees  degrees  (kyphotic group). Patients were then reclassified based 
      on GAP scores. Recovery ratios (RR) and the number of patients achieving the 
      minimal clinically important difference (MCID) were calculated for PROMs. 
      Standard descriptive statistics were reported for patient demographics and 
      outcomes data. Multiple linear regression analysis controlled for confounders. 
      Alpha was set at P < 0.05. RESULTS: There was no significant association between 
      change in focal lordosis and surgical complications including adjacent segment 
      disease (P = 0.282), instrumentation failure (P = 0.196), pseudarthrosis (P = 
      0.623), or revision surgery (P = 0.424). In addition, the only PROM affected by 
      change in focal lordosis was Mental Component Scores (DeltaMCS-12) (lordotic = 2.5, 
      neutral = 8.54, and kyphotic = 5.96, P = 0.017) and RR for MCS-12 (lordotic = 
      0.02, neutral = 0.14, kyphotic 0.10, P = 0.008). Linear regression analysis 
      demonstrated focal lordosis was a predictor of decreased improvement in MCS-12 (beta 
      = -6.45 [-11.03- -1.83], P = 0.007). GAP scores suggested patients who were 
      correctly proportioned had worse MCID compared to moderately disproportioned and 
      severely disproportioned patients (P = 0.024). CONCLUSIONS: The change in focal 
      lordosis not a significant predictor of change in PROMs for disability, pain, or 
      physical function. Proportioned patients based on the GAP score had worse MCID 
      for Oswestry Disability Index. LEVEL OF EVIDENCE: III.
CI  - Copyright: (c) 2022 Journal of Craniovertebral Junction and Spine.
FAU - Karamian, Brian A
AU  - Karamian BA
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - DiMaria, Stephen
AU  - DiMaria S
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - Lambrechts, Mark J
AU  - Lambrechts MJ
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - D'Antonio, Nicholas D
AU  - D'Antonio ND
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - Sawires, Andrew
AU  - Sawires A
AD  - Department of Orthopedic Surgery, Lenox Hill Hospital, New York City, New York, 
      USA.
FAU - Canseco, Jose A
AU  - Canseco JA
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - Kaye, I David
AU  - Kaye ID
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - Woods, Barrett I
AU  - Woods BI
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - Kurd, Mark F
AU  - Kurd MF
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - Rihn, Jeffery A
AU  - Rihn JA
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - Lee, Joseph K
AU  - Lee JK
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - Hilibrand, Alan S
AU  - Hilibrand AS
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - Kepler, Christopher K
AU  - Kepler CK
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - Vaccaro, Alexander R
AU  - Vaccaro AR
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
FAU - Schroeder, Gregory D
AU  - Schroeder GD
AD  - Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, 
      Pennsylvania, USA.
LA  - eng
PT  - Journal Article
DEP - 20220613
PL  - India
TA  - J Craniovertebr Junction Spine
JT  - Journal of craniovertebral junction & spine
JID - 101536746
PMC - PMC9274667
OTO - NOTNLM
OT  - Degenerative spondylolisthesis
OT  - lordosis
OT  - patient reported outcome measures
OT  - posterolateral fusion
OT  - transforaminal lumbar interbody fusion
COIS- There are no conflicts of interest.
EDAT- 2022/07/16 06:00
MHDA- 2022/07/16 06:01
PMCR- 2022/04/01
CRDT- 2022/07/15 02:41
PHST- 2021/11/17 00:00 [received]
PHST- 2022/03/01 00:00 [accepted]
PHST- 2022/07/15 02:41 [entrez]
PHST- 2022/07/16 06:00 [pubmed]
PHST- 2022/07/16 06:01 [medline]
PHST- 2022/04/01 00:00 [pmc-release]
AID - JCVJS-13-127 [pii]
AID - 10.4103/jcvjs.jcvjs_144_21 [doi]
PST - ppublish
SO  - J Craniovertebr Junction Spine. 2022 Apr-Jun;13(2):127-139. doi: 
      10.4103/jcvjs.jcvjs_144_21. Epub 2022 Jun 13.