The Effect Of Lumbar Fusion And Internal Fixation On Spinal Sagittal Balance And Clinical Efficacy

Objective: To evaluate the effect of lumbar fusion and internal fixation onspinal sagittal balance and its clinical efficacy in treating lumbar degenerativedisease. Methods: Sixty-two patients (34males,28females) with degenerativelumbar disease who underwent lumbar fusion and internal fixation from March2010to November2011were retrospectively reviewed in the present study. Themean age of the patients is52.4years (range24-84year). The duration of theirdisease is from6to384months (an average of58.3months). In the course ofpreoperation and follow-ups, the whole spine lateral X-rays of the patients weretaken, their thoracic kyphosis (TK), thoracolumbar junction angle (TLJ), lumbarlordosis (LL), sacral slope angle (SS), pelvic tilt angle (PT), pelvic angle ofincidence (PI), and sagittal vertical axis (SVA) were measured, and their VAS,ODI, and JOA scores were recorded, respectively. Results: All patients werefollowed up for3-18months (mean10.3months). Compared with those of preoperation, the patients’ VAS scores, ODI scores and JOA scores of the finalfollow-ups improved from5.3±2.1to1.2±1.1,45.4±17.0to32±15.6, and7.0±2.3to15±12.5, repectively. All of them had a significant difference(P<0.01). JOA improvement rate was even up to91%. However, there was nosignificant difference between the preoperation and the final follow-ups on TKand TLJ, which increased respectively from27.2±13.9to27.5±10.8, and7.5±14.6to8.6±10.0. Besides, there was a significant difference (P<0.05)between preoperation and the final follow-ups on LL, SS, PT and SVA. Thescores of them changed from34.5±16.1to41.2±11.8,26.2±9.4to30.4±8.3,21.2±8.8to18.9±7.6, and2.9±5.0to0.1±2.5, respectively. The parameters ofspine and pelvis were correlated with the VAS, ODI and JOA score. Packetanalysis, there was a significant difference (P<0.05) of SVA scores betweenpreoperatively and the final follow-ups with single and double segments fixation,but it was not different (P>0.05) with multi-segment fixation. LL and SVAscores were significant difference (P <0.05) between preoperatively and the finalfollow-ups with single-segment fixation in L4/5, but there were not significantdifference (P>0.05) in L5/S1. Conclusion: The lumbar fusion and internalfixation can effectively improve the lumbar lordosis which is important inmaintaining spinal sagittal balance and improving symptoms.