The Effect of Lordosis on Clinical Outcome After Spinal Fusion for One-level Degenerative Spondylolysthesis

NCT04174144 | Completed

• 1 other identifier: 0120-259/2019/6
• Study Type: observational
• Target: 32
• Locations: 1 country
• Sites: 1

Brief Summary

Degenerative spondylolisthesis is a common spinal degenerative disease. It is defined as the slippage of one vertebrae on the vertebrae bellow. In the process of spinal ageing and spinal joint degeneration, the spine becomes subjected to degenerative development that results in joint instability, shifting of vertebrae and can be responsible for a progressive kyphosis of the lumbar spine and sagittal imbalance with forward inclination of the trunk and chronic low back pain development. To address these changes and restore stability, lumbar spinal fusion has been developed and is nowadays a common procedure for unstable degenerative spine disorders. In the past several years, studies that highlight the importance of sagittal balance analysis with the restoration of adequate lumbar lordosis, have emerged. However, it remains a challenge to determine the correct amount of lumbar lordosis that is required for each patient to maintain optimal post-fusion sagittal balance. Additionally, the relationship between pelvic incidence (PI) and impact of LL correction has been highlighted in literature. The position of fused vertebrae is of paramount importance, as sagittal alignment should be done with minimizing muscle work during posture. Failure to reach proper sagittal balance can result in compensatory mechanisms such as increased pelvic tilt (PT), cervical and thoracic segment hyperextension, and knee flexion. These compensatory mechanisms have adverse effects such as chronic pain, disability and muscle fatigue. With this study the investigators aim to analyze long-term clinical and spinopelvic radiographic parameter outcomes of patients who underwent a one-level spinal fusion procedure for single level degenerative spondylolisthesis disease at a single institution.

Conditions

Spondylolisthesis Degenerative; Spinal Fusion

Keywords

Sagittal balance; Lumbar lordosis; Clinical outcomes

Outcome Measures

Primary Outcomes (3)

• ODI questionnaire

  The Oswestry Disability Index is an important tool that researchers and disability evaluators use to measure a patient's permanent functional disability. The test is considered the 'gold standard' of low back functional outcome tools. For each section the total possible score is 5. If all 10 sections are completed the maximal score is 50.

  7-9 years after TLIF procedure

• LL

  Radiographic evaluation of lumbar lordosis (LL): the angle between the upper endplate of the first lumbar vertebrae (L1) and the sacral endplate (S1).

  7-9 years after TLIF procedure

• SL

  Radiographic evaluation of segmental lordosis (SL): the angle between the cranial endplate of the upper and caudal endplate of the lower vertebrae of the operated segment.

  7-9 years after TLIF procedure

Secondary Outcomes (3)

• PT

  7-9 years after TLIF procedure

• SS

  7-9 years after TLIF procedure

• SVA

  7-9 years after TLIF procedure

Study Arms (1)

TLIF group

Participants with degenerative spondylolysthesis who underwent a single-level TLIF procedure.

Procedure: Single-level TLIF

Interventions

Single-level TLIF PROCEDURE

Transforaminal interbody fusion approach, using polyaxial pedicle screws (Xia®, Stryker Spine, Allendale, NJ, USA), combined with a crescent-shaped interbody cage (T-Plus®, Pioneer Surgical Technology, Marquette, MI, USA), bilateral facet joint removal and laminectomy.

TLIF group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Participants will be selected from patients who underwent a single-level TLIF procedure at Department of Orthopaedic surgery of Ljubljana University medical centre between 2011 and 2013.

You may qualify if:

• Patients with one-level degenerative spondylolysthesis treated with single-level TLIF at Department of Orthopaedic surgery of Ljubljana University medical centre between 2011 and 2013.
• TLIF performed at L3/4 or L4/5

You may not qualify if:

• Patients who refuse to participate in study or do not respond to our invitation
• Patients with additional instrumental spinal surgery or spinal trauma
• Patients with additional types of adult spinal deformity
• Patients with inflammatory spinal conditions
• Patients with flexion contractures of the hips or knees

Sponsors & Collaborators

• University Medical Centre Ljubljana: lead

Study Sites (1)

University Medical Centre Ljubljana

Ljubljana, 1000, Slovenia

Location

Related Publications (15)

• Barrey C, Roussouly P, Le Huec JC, D'Acunzi G, Perrin G. Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J. 2013 Nov;22 Suppl 6(Suppl 6):S834-41. doi: 10.1007/s00586-013-3030-z. Epub 2013 Sep 20.

  PMID: 24052406 BACKGROUND

• Barrey C, Darnis A. Current strategies for the restoration of adequate lordosis during lumbar fusion. World J Orthop. 2015 Jan 18;6(1):117-26. doi: 10.5312/wjo.v6.i1.117. eCollection 2015 Jan 18.

  PMID: 25621216 BACKGROUND

• Cheng X, Zhang F, Zhang K, Sun X, Zhao C, Li H, Li YM, Zhao J. Effect of Single-Level Transforaminal Lumbar Interbody Fusion on Segmental and Overall Lumbar Lordosis in Patients with Lumbar Degenerative Disease. World Neurosurg. 2018 Jan;109:e244-e251. doi: 10.1016/j.wneu.2017.09.154. Epub 2017 Oct 5.

  PMID: 28987851 BACKGROUND

• Ferrero E, Ould-Slimane M, Gille O, Guigui P; French Spine Society (SFCR). Sagittal spinopelvic alignment in 654 degenerative spondylolisthesis. Eur Spine J. 2015 Jun;24(6):1219-27. doi: 10.1007/s00586-015-3778-4. Epub 2015 Feb 5.

  PMID: 25652553 BACKGROUND

• Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000 Nov 15;25(22):2940-52; discussion 2952. doi: 10.1097/00007632-200011150-00017.

  PMID: 11074683 BACKGROUND

• Kuhta M, Bosnjak K, Vengust R. Failure to maintain segmental lordosis during TLIF for one-level degenerative spondylolisthesis negatively affects clinical outcome 5 years postoperatively: a prospective cohort of 57 patients. Eur Spine J. 2019 Apr;28(4):745-750. doi: 10.1007/s00586-019-05890-w. Epub 2019 Jan 24.

  PMID: 30680634 BACKGROUND

• Le Huec JC, Aunoble S, Philippe L, Nicolas P. Pelvic parameters: origin and significance. Eur Spine J. 2011 Sep;20 Suppl 5(Suppl 5):564-71. doi: 10.1007/s00586-011-1940-1. Epub 2011 Aug 10.

  PMID: 21830079 BACKGROUND

• Le Huec JC, Faundez A, Dominguez D, Hoffmeyer P, Aunoble S. Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review. Int Orthop. 2015 Jan;39(1):87-95. doi: 10.1007/s00264-014-2516-6. Epub 2014 Sep 6.

  PMID: 25192690 BACKGROUND

• Le Huec JC, Hasegawa K. Normative values for the spine shape parameters using 3D standing analysis from a database of 268 asymptomatic Caucasian and Japanese subjects. Eur Spine J. 2016 Nov;25(11):3630-3637. doi: 10.1007/s00586-016-4485-5. Epub 2016 Mar 7.

  PMID: 26951168 BACKGROUND

• Liang Y, Shi W, Jiang C, Chen Z, Liu F, Feng Z, Jiang X. Clinical outcomes and sagittal alignment of single-level unilateral instrumented transforaminal lumbar interbody fusion with a 4 to 5-year follow-up. Eur Spine J. 2015 Nov;24(11):2560-6. doi: 10.1007/s00586-015-3933-y. Epub 2015 Apr 14.

  PMID: 25870077 BACKGROUND

• Morvan G, Mathieu P, Vuillemin V, Guerini H, Bossard P, Zeitoun F, Wybier M. Standardized way for imaging of the sagittal spinal balance. Eur Spine J. 2011 Sep;20 Suppl 5(Suppl 5):602-8. doi: 10.1007/s00586-011-1927-y. Epub 2011 Aug 10.

  PMID: 21830081 BACKGROUND

• Ould-Slimane M, Lenoir T, Dauzac C, Rillardon L, Hoffmann E, Guigui P, Ilharreborde B. Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance. Eur Spine J. 2012 Jun;21(6):1200-6. doi: 10.1007/s00586-011-2124-8. Epub 2011 Dec 17.

  PMID: 22179755 BACKGROUND

• Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J. 2011 Sep;20 Suppl 5(Suppl 5):609-18. doi: 10.1007/s00586-011-1928-x. Epub 2011 Aug 2.

  PMID: 21809016 BACKGROUND

• Schwab F, Lafage V, Patel A, Farcy JP. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976). 2009 Aug 1;34(17):1828-33. doi: 10.1097/BRS.0b013e3181a13c08.

  PMID: 19644334 BACKGROUND

• Tye EY, Alentado VJ, Mroz TE, Orr RD, Steinmetz MP. Comparison of Clinical and Radiographic Outcomes in Patients Receiving Single-Level Transforaminal Lumbar Interbody Fusion With Removal of Unilateral or Bilateral Facet Joints. Spine (Phila Pa 1976). 2016 Sep;41(17):E1039-E1045. doi: 10.1097/BRS.0000000000001535.

  PMID: 26926356 BACKGROUND

MeSH Terms

Conditions

Lordosis

Condition Hierarchy (Ancestors)

Spinal Curvatures; Spinal Diseases; Bone Diseases; Musculoskeletal Diseases

Study Officials

• Rok Vengust, M.D, PhD

  Department of Orthopaedic surgery, University Medical Centre Ljubljana

  STUDY CHAIR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Resident of Orthopaedic surgery

Study Record Dates

• First Submitted: November 20, 2019
• First Posted: November 22, 2019
• Study Start: December 12, 2019
• Primary Completion: December 22, 2022
• Study Completion: June 23, 2023
• Last Updated: June 27, 2023

Record last verified: 2023-06

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, SAP, ICF, CSR
• Time Frame: Starting within 1 year after publication.
• Access Criteria: IPD and any additional supporting information will be shared by request with the Principal investigator.

Locations

SL (1)