Objective: The etiology of adjacent segment diseases and proximal junctional kyphosis has been related to biomechanical alterations after spinal operation. This study investigated the variation in pre- and postoperative range of motion in adjacent segments in patients with degenerative lumbar scoliosis (DLS) following posterior lumbar interbody fusion.
Patients and Methods: Eight patients with symptomatic DLS were analyzed using a biplane radiographic imaging system while adopting different postures. Synchronized biplane radiographs from L1 to S1 and the motions of each vertebra were acquired pre- and postoperatively. Six degrees of freedom (DOF) of kinematic data were compared between different postoperative pelvic incidence-lumbar lordosis (PI-LL) groups (group A: PI-LL = −10°–~10°; group B: PI-LL = 10°–~20°).
Results: After surgery, the axial rotational movement (primary rotation) during flexion–extension, bending, and torsion in the first adjacent segment at L3-4 decreased significantly in three patients (8.14 ± 2.78 vs. 15.13 ± 6.71; 8.36 ± 5.59 vs. 9.08 ± 3.57; 5.07 ± 0.56 vs. 9.25 ± 5.06). At this level, the torsion around the crania-caudal (CC) axis during bending (1.48 ± 1.01 vs. 7.05 ± 5.84, p < 0.05) and flexion around the mediolateral (ML) axis and bending rotation around the anterioposterior (AP) axis during torsion decreased postoperatively (6.37 ± 6.01 vs. 13.83 ± 8.12, 4.53 ± 1.97 vs. 13.06 ± 6.65; p < 0.05, p < 0.05). After surgery, in the L1-2 segment, translation along the ML direction decreased during bending (3.69 ± 2.12 vs. 14.76 ± 7.99, p < 0.05). In the adjacent L5-S1 segment, primary flexed rotation around the ML axis increased in group B postoperatively during flexion–extension, but decreased in group A (6.08 ± 1.17 vs. −13.41 ± 2.99, p < 0.05). Coupled flexed rotation around the ML axis decreased and showed the opposite trend during bending (−10.76 ± 5.51 vs. 18.12 ± 39.83, p < 0.05).
Conclusions: Postoperative coupled motion at the adjacent segment decreased, which indicates an improved balance of the spinal order compared to before the surgery. However, primary motion changed according to the location of the upper instrumented vertebrae. Our results indicate that postoperative PI-LL values between 10° and 20° were associated with lower coupled motion and higher primary motion at L5-S1.
| [1] |
S. Jimbo, T. Kobayashi, K. Aono, Y. Atsuta, and T. Matsuno, “Epidemiology of Degenerative Lumbar Scoliosis: A Community-Based Cohort Study,” Spine (Phila Pa 1976) 37, no. 20 (2012): 1763–1770, https://doi.org/10.1097/BRS.0b013e3182575eaa.
|
| [2] |
M. Aebi, “The Adult Scoliosis,” European Spine Journal 14, no. 10 (2005): 925–948, https://doi.org/10.1007/s00586-005-1053-9.
|
| [3] |
G. Cheh, K. H. Bridwell, L. G. Lenke, et al., “Adjacent Segment Disease Following lumbar/Thoracolumbar Fusion With Pedicle Screw Instrumentation: A Minimum 5-Year Follow-Up,” Spine (Phila Pa 1976) 32, no. 20 (2007): 2253–2257, https://doi.org/10.1097/BRS.0b013e31814b2d8e.
|
| [4] |
G. Ghiselli, J. C. Wang, N. N. Bhatia, et al., “Adjacent Segment Degeneration in the Lumbar Spine,” Journal of Bone and Joint Surgery. American Volume 86, no. 7 (2004): 1497–1503, https://doi.org/10.2106/00004623-200407000-00020.
|
| [5] |
M. Djurasovic, S. D. Glassman, J. M. Howard, A. G. Copay, and L. Y. Carreon, “Health-Related Quality of Life Improvements in Patients Undergoing Lumbar Spinal Fusion as a Revision Surgery,” Spine (Phila Pa 1976) 36, no. 4 (2011): 269–276, https://doi.org/10.1097/BRS.0b013e3181cf1091.
|
| [6] |
Y. J. Kim, K. H. Bridwell, L. G. Lenke, C. R. Glattes, S. Rhim, and G. Cheh, “Proximal Junctional Kyphosis in Adult Spinal Deformity After Segmental Posterior Spinal Instrumentation and Fusion: Minimum Five-Year Follow-Up,” Spine (Phila Pa 1976) 33, no. 20 (2008): 2179–2184, https://doi.org/10.1097/BRS.0b013e31817c0428.
|
| [7] |
L. Bastian, U. Lange, C. Knop, G. Tusch, and M. Blauth, “Evaluation of the Mobility of Adjacent Segments After Posterior Thoracolumbar Fixation: A Biomechanical Study,” European Spine Journal 10, no. 4 (2001): 295–300, https://doi.org/10.1007/s005860100278.
|
| [8] |
P. Ekman, H. Möller, A. Shalabi, Y. X. Yu, and R. Hedlund, “A Prospective Randomised Study on the Long-Term Effect of Lumbar Fusion on Adjacent Disc Degeneration,” European Spine Journal 18, no. 8 (2009): 1175–1186, https://doi.org/10.1007/s00586-009-0947-3.
|
| [9] |
Y. J. Kim, K. H. Bridwell, L. G. Lenke, J. Kim, and S. K. Cho, “Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Following Segmental Posterior Spinal Instrumentation and Fusion: Minimum 5-Year Follow-Up,” Spine (Phila Pa 1976) 30, no. 18 (2005): 2045–2050, https://doi.org/10.1097/01.brs.0000179084.45839.ad.
|
| [10] |
Y. J. Kim, L. G. Lenke, K. H. Bridwell, et al., “Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis After 3 Different Types of Posterior Segmental Spinal Instrumentation and Fusions: Incidence and Risk Factor Analysis of 410 Cases,” Spine (Phila Pa 1976) 32, no. 24 (2007): 2731–2738, https://doi.org/10.1097/BRS.0b013e31815a7ead.
|
| [11] |
Y. Aoki, A. Nakajima, H. Takahashi, et al., “Influence of Pelvic Incidence-Lumbar Lordosis Mismatch on Surgical Outcomes of Short-Segment Transforaminal Lumbar Interbody Fusion,” BMC Musculoskeletal Disorders 16 (2015): 213, https://doi.org/10.1186/s12891-015-0676-1.
|
| [12] |
J. Du, H. Dong, M. Huang, V. V. Silberschmidt, L. Meng, and J. Miao, “Regional Variations of Mechanical Responses of IVD to 7 Different Motions: An in Vivo Study Combined With FEA and DFIS,” Journal of the Mechanical Behavior of Biomedical Materials 160 (2024): 106785, https://doi.org/10.1016/j.jmbbm.2024.106785.
|
| [13] |
J. Cegoñino, A. Calvo-Echenique, and A. Pérez-del Palomar, “Influence of Different Fusion Techniques in Lumbar Spine Over the Adjacent Segments: A 3D Finite Element Study,” Journal of Orthopaedic Research 33, no. 7 (2015): 993–1000, https://doi.org/10.1002/jor.22854.
|
| [14] |
D. H. Chow, K. D. Luk, J. H. Evans, and J. C. Leong, “Effects of Short Anterior Lumbar Interbody Fusion on Biomechanics of Neighboring Unfused Segments,” Spine (Phila Pa 1976) 21, no. 5 (1996): 549–555, https://doi.org/10.1097/00007632-199603010-00004.
|
| [15] |
S. Tang, “Comparison of Posterior Versus Transforaminal Lumbar Interbody Fusion Using Finite Element Analysis. Influence on Adjacent Segmental Degeneration,” Saudi Medical Journal 36, no. 8 (2015): 993–996, https://doi.org/10.15537/smj.2015.8.11759.
|
| [16] |
S. R. Chen, C. M. LeVasseur, S. Pitcairn, et al., “In Vivo Evidence of Early Instability and Late Stabilization in Motion Segments Immediately Superior to Anterior Cervical Arthrodesis,” Spine (Phila Pa 1976) 47, no. 17 (2022): 1234–1240, https://doi.org/10.1097/brs.0000000000004388.
|
| [17] |
J. D. Auerbach, K. J. Jones, A. H. Milby, O. A. Anakwenze, and R. A. Balderston, “Segmental Contribution Toward Total Lumbar Range of Motion in Disc Replacement and Fusions: A Comparison of Operative and Adjacent Levels,” Spine (Phila Pa 1976) 34, no. 23 (2009): 2510–2517, https://doi.org/10.1097/BRS.0b013e3181af2622.
|
| [18] |
P. Axelsson, R. Johnsson, and B. Strömqvist, “Adjacent Segment Hypermobility After Lumbar Spine Fusion: No Association With Progressive Degeneration of the Segment 5 Years After Surgery,” Acta Orthopaedica 78, no. 6 (2007): 834–839, https://doi.org/10.1080/17453670710014635.
|
| [19] |
H. J. Kim, S. H. Moon, H. J. Chun, et al., “Comparison of Mechanical Motion Profiles Following Instrumented Fusion and Non-Instrumented Fusion at the L4-5 Segment,” Clinical and Investigative Medicine 32, no. 1 (2009): E64–E69, https://doi.org/10.25011/cim.v32i1.5089.
|
| [20] |
C. Zhou, T. Cha, W. Wang, R. Guo, and G. Li, “Investigation of Alterations in the Lumbar Disc Biomechanics at the Adjacent Segments After Spinal Fusion Using a Combined in Vivo and in Silico Approach,” Annals of Biomedical Engineering 49, no. 2 (2021): 601–616, https://doi.org/10.1007/s10439-020-02588-9.
|
| [21] |
P. McMullin, D. Emmett, A. Gibbons, et al., “Dynamic Segmental Kinematics of the Lumbar Spine During Diagnostic Movements,” Frontiers in Bioengineering and Biotechnology 11 (2023): 1209472, https://doi.org/10.3389/fbioe.2023.1209472.
|
| [22] |
S. Wang, P. Passias, G. Li, et al., “Measurement of Vertebral Kinematics Using Noninvasive Image Matching Method-Validation and Application,” Spine (Phila Pa 1976) 33, no. 11 (2008): E355–E361, https://doi.org/10.1097/BRS.0b013e3181715295.
|
| [23] |
M. A. Hayes, S. F. Tompkins, W. A. Herndon, et al., “Clinical and Radiological Evaluation of Lumbosacral Motion Below Fusion Levels in Idiopathic Scoliosis,” Spine (Phila Pa 1976) 13, no. 10 (1988): 1161–1167, https://doi.org/10.1097/00007632-198810000-00019.
|
| [24] |
R. Haddas, M. Xu, I. Lieberman, and J. Yang, “Finite Element Based-Analysis for Pre and Post Lumbar Fusion of Adult Degenerative Scoliosis Patients,” Spine Deformity 7, no. 4 (2019): 543–552, https://doi.org/10.1016/j.jspd.2018.11.008.
|
| [25] |
A. Rohlmann, N. K. Burra, T. Zander, and G. Bergmann, “Comparison of the Effects of Bilateral Posterior Dynamic and Rigid Fixation Devices on the Loads in the Lumbar Spine: A Finite Element Analysis,” European Spine Journal 16, no. 8 (2007): 1223–1231, https://doi.org/10.1007/s00586-006-0292-8.
|
| [26] |
M. Malakoutian, D. Volkheimer, J. Street, M. F. Dvorak, H. J. Wilke, and T. R. Oxland, “Do in Vivo Kinematic Studies Provide Insight Into Adjacent Segment Degeneration? A Qualitative Systematic Literature Review,” European Spine Journal 24, no. 9 (2015): 1865–1881, https://doi.org/10.1007/s00586-015-3992-0.
|
| [27] |
D. Volkheimer, M. Malakoutian, T. R. Oxland, and H. J. Wilke, “Limitations of Current in Vitro Test Protocols for Investigation of Instrumented Adjacent Segment Biomechanics: Critical Analysis of the Literature,” European Spine Journal 24, no. 9 (2015): 1882–1892, https://doi.org/10.1007/s00586-015-4040-9.
|
| [28] |
F. Xu, J. Lin, S. Jiang, et al., “In Vivo Segmental Vertebral Kinematics in Patients With Degenerative Lumbar Scoliosis,” European Spine Journal 33, no. 2 (2024): 571–581, https://doi.org/10.1007/s00586-023-07974-0.
|
| [29] |
K. Y. Ha, M. J. Schendel, J. L. Lewis, et al., “Effect of Immobilization and Configuration on Lumbar Adjacent-Segment Biomechanics,” Journal of Spinal Disorders 6, no. 2 (1993): 99–105.
|
| [30] |
D. V. Ambati, E. K. Wright,, R. A. Lehman,, D. G. Kang, S. C. Wagner, and A. E. Dmitriev, “Bilateral Pedicle Screw Fixation Provides Superior Biomechanical Stability in Transforaminal Lumbar Interbody Fusion: A Finite Element Study,” Spine Journal 15, no. 8 (2015): 1812–1822, https://doi.org/10.1016/j.spinee.2014.06.015.
|
| [31] |
A. A. White, and M. M. Panjabi, “The Basic Kinematics of the Human Spine. A Review of Past and Current Knowledge,” Spine (Phila Pa 1976) 3, no. 1 (1978): 12–20, https://doi.org/10.1097/00007632-197803000-00003.
|
| [32] |
R. A. Wawrose, C. M. LeVasseur, V. K. Byrapogu, et al., “In Vivo Changes in Adjacent Segment Kinematics After Lumbar Decompression and Fusion,” Journal of Biomechanics 102 (2020): 109515, https://doi.org/10.1016/j.jbiomech.2019.109515.
|
| [33] |
L. L. Wiltse, S. E. Radecki, H. M. Biel, et al., “Comparative Study of the Incidence and Severity of Degenerative Change in the Transition Zones After Instrumented Versus Noninstrumented Fusions of the Lumbar Spine,” Journal of Spinal Disorders 12, no. 1 (1999): 27–33.
|
| [34] |
C. M. E. Rustenburg, I. Kingma, R. M. Holewijn, et al., “Biomechanical Properties in Motion of Lumbar Spines With Degenerative Scoliosis,” Journal of Biomechanics 102 (2020): 109495, https://doi.org/10.1016/j.jbiomech.2019.109495.
|
| [35] |
D. G. Tobert, V. Antoci, S. P. Patel, E. Saadat, and C. M. Bono, “Adjacent Segment Disease in the Cervical and Lumbar Spine,” Clinical Spine Surgery: A Spine Publication 30, no. 3 (2017): 94–101, https://doi.org/10.1097/bsd.0000000000000442.
|
| [36] |
B. W. Cunningham, Y. Kotani, P. S. McNulty, A. Cappuccino, and P. C. McAfee, “The Effect of Spinal Destabilization and Instrumentation on Lumbar Intradiscal Pressure: An in Vitro Biomechanical Analysis,” Spine (Phila Pa 1976) 22, no. 22 (1997): 2655–2663, https://doi.org/10.1097/00007632-199711150-00014.
|
| [37] |
M. L. Prasarn, D. Baria, E. Milne, L. Latta, and W. Sukovich, “Adjacent-Level Biomechanics After Single Versus Multilevel Cervical Spine Fusion,” Journal of Neurosurgery. Spine 16, no. 2 (2012): 172–177, https://doi.org/10.3171/2011.10.spine11116.
|
| [38] |
K. Y. Ha, W. H. Jang, Y. H. Kim, et al., “Clinical Relevance of the SRS-Schwab Classification for Degenerative Lumbar Scoliosis,” Spine (Phila Pa 1976) 41, no. 5 (2016): E282–E288, https://doi.org/10.1097/brs.0000000000001229.
|
| [39] |
M. N. Kumar, A. Baklanov, and D. Chopin, “Correlation Between Sagittal Plane Changes and Adjacent Segment Degeneration Following Lumbar Spine Fusion,” European Spine Journal 10, no. 4 (2001): 314–319, https://doi.org/10.1007/s005860000239.
|
| [40] |
Z. Zhu, L. Xu, F. Zhu, et al., “Sagittal Alignment of Spine and Pelvis in Asymptomatic Adults: Norms in Chinese Populations,” Spine (Phila Pa 1976) 39, no. 1 (2014): E1–E6, https://doi.org/10.1097/brs.0000000000000022.
|
| [41] |
F. J. Schwab, B. Blondel, S. Bess, et al., “Radiographical Spinopelvic Parameters and Disability in the Setting of Adult Spinal Deformity: A Prospective Multicenter Analysis,” Spine (Phila Pa 1976) 38, no. 13 (2013): e803–e812, https://doi.org/10.1097/BRS.0b013e318292b7b9.
|
| [42] |
F. Schwab, A. Patel, B. Ungar, J.-P. Farcy, and V. Lafage, “Adult Spinal Deformity-Postoperative Standing Imbalance: How Much Can You Tolerate? An Overview of Key Parameters in Assessing Alignment and Planning Corrective Surgery,” Spine (Phila Pa 1976) 35, no. 25 (2010): 2224–2231, https://doi.org/10.1097/BRS.0b013e3181ee6bd4.
|
| [43] |
R. Lafage, F. Schwab, V. Challier, et al., “Defining Spino-Pelvic Alignment Thresholds: Should Operative Goals in Adult Spinal Deformity Surgery Account for Age?,” Spine (Phila Pa 1976) 41, no. 1 (2016): 62–68, https://doi.org/10.1097/brs.0000000000001171.
|
| [44] |
R. Lafage, J. S. Smith, J. Elysee, et al., “Sagittal Age-Adjusted Score (SAAS) for Adult Spinal Deformity (ASD) More Effectively Predicts Surgical Outcomes and Proximal Junctional Kyphosis Than Previous Classifications,” Spine Deform 10, no. 1 (2022): 121–131, https://doi.org/10.1007/s43390-021-00397-1.
|
| [45] |
Z. J. Liu, B. P. Qian, Y. Qiu, S. H. Mao, J. Jiang, and B. Wang, “Does Postoperative PI-LL Mismatching Affect Surgical Outcomes in Thoracolumbar Kyphosis Associated With Ankylosing Spondylitis Patients?,” Clinical Neurology and Neurosurgery 169 (2018): 71–76, https://doi.org/10.1016/j.clineuro.2018.04.006.
|
| [46] |
H. Bai, Y. Li, C. Liu, et al., “Surgical Management of Degenerative Lumbar Scoliosis Associated With Spinal Stenosis: Does the PI-LL Matter?,” Spine (Phila Pa 1976) 45, no. 15 (2020): 1047–1054, https://doi.org/10.1097/brs.0000000000003465.
|
| [47] |
X. Y. Sun, X. N. Zhang, and Y. Hai, “Optimum Pelvic Incidence Minus Lumbar Lordosis Value After Operation for Patients With Adult Degenerative Scoliosis,” Spine Journal 17, no. 7 (2017): 983–989, https://doi.org/10.1016/j.spinee.2017.03.008.
|
| [48] |
H. C. Zhang, Z. F. Zhang, Z. H. Wang, et al., “Optimal Pelvic Incidence Minus Lumbar Lordosis Mismatch After Long Posterior Instrumentation and Fusion for Adult Degenerative Scoliosis,” Orthopedic Surgery 9, no. 3 (2017): 304–310, https://doi.org/10.1111/os.12343.
|
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