J Korean Soc Spine Surg.  2013 Mar;20(1):1-7. 10.4184/jkss.2013.20.1.1.

Correlation of Adjacent Segmental Disease with Tilt Angles of the Upper and Lower Instrumented Vertebra in the Degenerative Lumbar Scoliosis

• Yang JY
• Lee JK
• Joo YB
• Cha SM
• Park JY

• KMID: 2209494
• DOI: http://doi.org/10.4184/jkss.2013.20.1.1

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To evaluate the correlation of adjacent segmental disease with tilt angles of the upper and lower instrumented vertebra after instrumented posterolateral fusion for degenerative lumbar scoliosis. SUMMARY OF LITERATURE REVIEW: There has been no study of radiologic measurement and decision of fusion level using the angle of pedicle screws inserted for treatment of degenerative lumbar scoliosis.
MATERIALS AND METHODS
From 2004 to 2008, 74 patients that underwent decompression and posterolateral fusion for degenerative lumbar scoliosis were included in this study. In all cases, instrumentation and posterolateral fusion were both performed. The sex ratio was 31:43, the mean age was 68.7 years and the mean follow up duration was 37.4 months. The angle between each upper end plate of the upper vertebral body and lower end plate of the lower vertebral body of the fusion, and the line parallel to the axis of the sagittal line of vertebrae was each defined as UIV-a and LIV-b. The correlation of development of adjacent segment disease and UIV-a, and LIV-b angle was investigated.
RESULTS
Sum of the absolute value of UIV-a and LIV-b had a statistically significant positive correlation with that of adjacent segment disease. Also, UIV-a alone, had a statistically positive correlation with the development of proximal adjacent segment disease.
CONCLUSIONS
Since it is proven that adjacent segment disease has positive correlation with the sum of the absolute value of UIV-a and LIV-b, the extent of fusion should be adjusted to make the line parallel to the line perpendicular to the sagittal surface.

Keyword

Degenerative lumbar scoliosis; Posterolateral fusion; Fusion level; Adjacent segment disease

MeSH Terms

Axis, Cervical Vertebra
Decompression
Follow-Up Studies
Humans
Retrospective Studies
Scoliosis
Sex Ratio
Spine

Figure

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  Fig. 1. UIV-a and UIV-b are defined angles formed by 2 lines of the 1st line along the upper end plate of the most upper instrumented vertebra or the lower end plate of the most lower instrumented vertebra and the 2nd sagittal vertical axis of the vertebrae respectively.

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  Fig. 2. 67-year-old patient with degenerative lumbar scoliosis and stenosis (A) Preoperative radiographs (B) Postoperative radiographs after decompression and posterolateral fusion on L3-S1. UIV-a was 15.2 degrees and LIV-b was 17.9 degrees in this radiographs (C) Last Follow-up radiographs 27 months after the surgery show degenerative changes and development of proximal adjacent segment disease (disc space narrow and sclerosis) at the L2-3 level.

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