A Retrospective Analysis of the L3-L4 Disc and Spinopelvic Parameters on Outcomes in Thoracolumbar Fusion: Was Art Steffee Right?

Authors

• Mark M. Kodsy, Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA. Electronic address: mkodsy@neomed.edu.
• Harvey E. Freitag, Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
• Robert D. Winkelman, Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
• Nicholas M. Rabah, Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
• Bryan S. Lee, Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
• Ryan Honomichl, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
• Nicolas Thompson, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
• Jason W. Savage, Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
• R Douglas Orr, Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
• Edward C. Benzel, Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
• Iain H. Kalfas, Center for Spine Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.

Document Type

Article

Abstract

OBJECTIVE: To determine whether the L3-L4 disc angle may be a surrogate marker for global lumbar alignment in thoracolumbar fusion surgery and to explore the relationship between radiographic and patient-reported outcomes after thoracolumbar fusion surgery. METHODS: Retrospective chart review was conducted on patients who had undergone a lumbar fusion involving levels from T9 to pelvis. EuroQol-Five Dimension (EQ-5D-3L) scores and adverse events including adjacent-segment disease and degeneration, pseudoarthrosis, proximal junctional kyphosis, stenosis, and reoperation were collected. Pre- and postoperative spinopelvic parameters were measured on weight-bearing radiographs, with the L3-L4 disc angle of novel interest. Univariate logistic and linear regression were performed to assess the associations of radiographic parameters with adverse event incidence and improvement in EQ-5D-3L, respectively. RESULTS: In total, 182 patients met inclusion criteria. Univariable analysis revealed that increased magnitude of L3-L4 disc angle, anterior pelvic tilt, and pelvic incidence measures are associated with increased likelihood of developing postoperative adverse events. Conversely, increased lumbar lordosis demonstrated a decreased incidence of developing a postoperative adverse event. Linear regression showed that radiographic parameters did not significantly correlate with postoperative EQ-5D-3L scores, although scores were significantly improved postfusion in all dimensions except Self-Care (P = 0.51). CONCLUSIONS: L3-L4 disc angle magnitude may serve as a surrogate marker of global lumbar alignment. The degree of spinopelvic alignment did not correlate to improvement in EQ-5D-3L score in the present study, suggesting that quality of life metric change may not be a sensitive or specific marker of postfusion alignment.

Medical Subject Headings

Humans; Lordosis (surgery); Lumbar Vertebrae (diagnostic imaging, surgery); Quality of Life; Retrospective Studies; Spinal Fusion (methods)

Publication Date

3-1-2022

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

159

First Page

e399

Last Page

e406

PubMed ID

34954442

Digital Object Identifier (DOI)

10.1016/j.wneu.2021.12.065

Recommended Citation

Kodsy, Mark M.; Freitag, Harvey E.; Winkelman, Robert D.; Rabah, Nicholas M.; Lee, Bryan S.; Honomichl, Ryan; Thompson, Nicolas; Savage, Jason W.; Orr, R Douglas; Benzel, Edward C.; and Kalfas, Iain H., "A Retrospective Analysis of the L3-L4 Disc and Spinopelvic Parameters on Outcomes in Thoracolumbar Fusion: Was Art Steffee Right?" (2022). Neurosurgery. 1852.
https://scholar.barrowneuro.org/neurosurgery/1852