Preoperative Radiographic Predictors of Subsequent Fusion after Lumbar Decompression Surgery

Mark J. Lambrechts; Jeremy C. Heard; Nicholas D. D'Antonio; Yunsoo Lee; Rajkishen Narayanan; Teeto Ezeonu; Garrett Breyer; John Paulik; Sydney Somers; Anthony J. Labarbiera; Jose A. Canseco; Mark F. Kurd; Ian D. Kaye; Alan S. Hilibrand; Alexander R. Vaccaro; Gregory D. Schroeder; Christopher K. Kepler

doi:10.1097/BRS.0000000000005109

Preoperative Radiographic Predictors of Subsequent Fusion after Lumbar Decompression Surgery

Mark J. Lambrechts, Jeremy C. Heard, Nicholas D. D'Antonio, Yunsoo Lee, Rajkishen Narayanan, Teeto Ezeonu, Garrett Breyer, John Paulik, Sydney Somers, Anthony J. Labarbiera, Jose A. Canseco, Mark F. Kurd, Ian D. Kaye, Alan S. Hilibrand, Alexander R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler

Division of Spine

Research output: Contribution to journal › Article › peer-review

Abstract

Study Design. Retrospective cohort study. Objective. The purpose of this study is to determine which demographic, surgical, and radiographic preoperative characteristics are most associated with the need for subsequent fusion after decompression lumbar spinal surgery. Summary of Background Data. There is a relatively high rate of the need for repeat decompression or fusion after an index decompression procedure for degenerative spine disease. Nevertheless, there is a dearth of literature identifying risk factors for lumbar fusion following decompression surgery Methods. Patients 18 years or older receiving a primary lumbar decompression surgery within the levels of L3-S1 between 2011 and 2020 were identified. All patients had preoperative radiographs and 2 years of follow-up data. Chart review was performed for surgical characteristics and demographics. The sagittal parameters included lumbar lordosis (LL), segmental lordosis (SL), anterior disk height (aDH), posterior disk height (pDH), sacral slope (SS), and pelvic tilt (PT). Pelvic incidence (PI=PT+SS) and pelvic incidence minus lumbar lordosis (PI-LL) were calculated. In addition, the Roussouly classification was determined for each patient. Bivariant and multivariant analyses were performed. Results. Of the 363 patients identified in this study, 96 patients had a fusion after their index decompression surgery. Multivariable analysis identified involvement of L4-L5 level in the decompression [odds ratio (OR)=1.83 (1.09-3.14), P=0.026], increased L5-S1 segmental lordosis [OR=1.08 (1.03-1.13), P=0.001], decreased SS [OR=0.96 (0.93-0.99), P=0.023], and decreased endplate obliquity [OR=0.88 (0.77-0.99), P=0.040] as significant independent predictors of fusion after decompression surgery. Conclusions. This is one of the first studies to assess preoperative sagittal parameters in conjunction with demographic variables to determine predictors of the need for fusion after index decompression. We demonstrated that decompression at L4-L5, greater L5-S1 segmental lordosis, decreased sacral slope, and decreased endplate obliquity were associated with higher rates of fusion after decompression surgery.

Original language	English
Pages (from-to)	1598-1606
Number of pages	9
Journal	Spine
Volume	49
Issue number	22
DOIs	https://doi.org/10.1097/BRS.0000000000005109
State	Published - Nov 15 2024

Keywords

decompression surgery
fusion surgery
lumbar lordosis
lumbar spine
sagittal alignment

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10.1097/BRS.0000000000005109

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Lambrechts, M. J., Heard, J. C., D'Antonio, N. D., Lee, Y., Narayanan, R., Ezeonu, T., Breyer, G., Paulik, J., Somers, S., Labarbiera, A. J., Canseco, J. A., Kurd, M. F., Kaye, I. D., Hilibrand, A. S., Vaccaro, A. R., Schroeder, G. D., & Kepler, C. K. (2024). Preoperative Radiographic Predictors of Subsequent Fusion after Lumbar Decompression Surgery. Spine, 49(22), 1598-1606. https://doi.org/10.1097/BRS.0000000000005109

@article{aad0e47431a94385b2896feb69d61866,

title = "Preoperative Radiographic Predictors of Subsequent Fusion after Lumbar Decompression Surgery",

abstract = "Study Design. Retrospective cohort study. Objective. The purpose of this study is to determine which demographic, surgical, and radiographic preoperative characteristics are most associated with the need for subsequent fusion after decompression lumbar spinal surgery. Summary of Background Data. There is a relatively high rate of the need for repeat decompression or fusion after an index decompression procedure for degenerative spine disease. Nevertheless, there is a dearth of literature identifying risk factors for lumbar fusion following decompression surgery Methods. Patients 18 years or older receiving a primary lumbar decompression surgery within the levels of L3-S1 between 2011 and 2020 were identified. All patients had preoperative radiographs and 2 years of follow-up data. Chart review was performed for surgical characteristics and demographics. The sagittal parameters included lumbar lordosis (LL), segmental lordosis (SL), anterior disk height (aDH), posterior disk height (pDH), sacral slope (SS), and pelvic tilt (PT). Pelvic incidence (PI=PT+SS) and pelvic incidence minus lumbar lordosis (PI-LL) were calculated. In addition, the Roussouly classification was determined for each patient. Bivariant and multivariant analyses were performed. Results. Of the 363 patients identified in this study, 96 patients had a fusion after their index decompression surgery. Multivariable analysis identified involvement of L4-L5 level in the decompression [odds ratio (OR)=1.83 (1.09-3.14), P=0.026], increased L5-S1 segmental lordosis [OR=1.08 (1.03-1.13), P=0.001], decreased SS [OR=0.96 (0.93-0.99), P=0.023], and decreased endplate obliquity [OR=0.88 (0.77-0.99), P=0.040] as significant independent predictors of fusion after decompression surgery. Conclusions. This is one of the first studies to assess preoperative sagittal parameters in conjunction with demographic variables to determine predictors of the need for fusion after index decompression. We demonstrated that decompression at L4-L5, greater L5-S1 segmental lordosis, decreased sacral slope, and decreased endplate obliquity were associated with higher rates of fusion after decompression surgery.",

keywords = "decompression surgery, fusion surgery, lumbar lordosis, lumbar spine, sagittal alignment",

author = "Lambrechts, {Mark J.} and Heard, {Jeremy C.} and D'Antonio, {Nicholas D.} and Yunsoo Lee and Rajkishen Narayanan and Teeto Ezeonu and Garrett Breyer and John Paulik and Sydney Somers and Labarbiera, {Anthony J.} and Canseco, {Jose A.} and Kurd, {Mark F.} and Kaye, {Ian D.} and Hilibrand, {Alan S.} and Vaccaro, {Alexander R.} and Schroeder, {Gregory D.} and Kepler, {Christopher K.}",

year = "2024",

month = nov,

day = "15",

doi = "10.1097/BRS.0000000000005109",

language = "English",

volume = "49",

pages = "1598--1606",

journal = "Spine",

issn = "0362-2436",

number = "22",

}

Lambrechts, MJ, Heard, JC, D'Antonio, ND, Lee, Y, Narayanan, R, Ezeonu, T, Breyer, G, Paulik, J, Somers, S, Labarbiera, AJ, Canseco, JA, Kurd, MF, Kaye, ID, Hilibrand, AS, Vaccaro, AR, Schroeder, GD & Kepler, CK 2024, 'Preoperative Radiographic Predictors of Subsequent Fusion after Lumbar Decompression Surgery', Spine, vol. 49, no. 22, pp. 1598-1606. https://doi.org/10.1097/BRS.0000000000005109

TY - JOUR

T1 - Preoperative Radiographic Predictors of Subsequent Fusion after Lumbar Decompression Surgery

AU - Lambrechts, Mark J.

AU - Heard, Jeremy C.

AU - D'Antonio, Nicholas D.

AU - Lee, Yunsoo

AU - Narayanan, Rajkishen

AU - Ezeonu, Teeto

AU - Breyer, Garrett

AU - Paulik, John

AU - Somers, Sydney

AU - Labarbiera, Anthony J.

AU - Canseco, Jose A.

AU - Kurd, Mark F.

AU - Kaye, Ian D.

AU - Hilibrand, Alan S.

AU - Vaccaro, Alexander R.

AU - Schroeder, Gregory D.

AU - Kepler, Christopher K.

PY - 2024/11/15

Y1 - 2024/11/15

N2 - Study Design. Retrospective cohort study. Objective. The purpose of this study is to determine which demographic, surgical, and radiographic preoperative characteristics are most associated with the need for subsequent fusion after decompression lumbar spinal surgery. Summary of Background Data. There is a relatively high rate of the need for repeat decompression or fusion after an index decompression procedure for degenerative spine disease. Nevertheless, there is a dearth of literature identifying risk factors for lumbar fusion following decompression surgery Methods. Patients 18 years or older receiving a primary lumbar decompression surgery within the levels of L3-S1 between 2011 and 2020 were identified. All patients had preoperative radiographs and 2 years of follow-up data. Chart review was performed for surgical characteristics and demographics. The sagittal parameters included lumbar lordosis (LL), segmental lordosis (SL), anterior disk height (aDH), posterior disk height (pDH), sacral slope (SS), and pelvic tilt (PT). Pelvic incidence (PI=PT+SS) and pelvic incidence minus lumbar lordosis (PI-LL) were calculated. In addition, the Roussouly classification was determined for each patient. Bivariant and multivariant analyses were performed. Results. Of the 363 patients identified in this study, 96 patients had a fusion after their index decompression surgery. Multivariable analysis identified involvement of L4-L5 level in the decompression [odds ratio (OR)=1.83 (1.09-3.14), P=0.026], increased L5-S1 segmental lordosis [OR=1.08 (1.03-1.13), P=0.001], decreased SS [OR=0.96 (0.93-0.99), P=0.023], and decreased endplate obliquity [OR=0.88 (0.77-0.99), P=0.040] as significant independent predictors of fusion after decompression surgery. Conclusions. This is one of the first studies to assess preoperative sagittal parameters in conjunction with demographic variables to determine predictors of the need for fusion after index decompression. We demonstrated that decompression at L4-L5, greater L5-S1 segmental lordosis, decreased sacral slope, and decreased endplate obliquity were associated with higher rates of fusion after decompression surgery.

AB - Study Design. Retrospective cohort study. Objective. The purpose of this study is to determine which demographic, surgical, and radiographic preoperative characteristics are most associated with the need for subsequent fusion after decompression lumbar spinal surgery. Summary of Background Data. There is a relatively high rate of the need for repeat decompression or fusion after an index decompression procedure for degenerative spine disease. Nevertheless, there is a dearth of literature identifying risk factors for lumbar fusion following decompression surgery Methods. Patients 18 years or older receiving a primary lumbar decompression surgery within the levels of L3-S1 between 2011 and 2020 were identified. All patients had preoperative radiographs and 2 years of follow-up data. Chart review was performed for surgical characteristics and demographics. The sagittal parameters included lumbar lordosis (LL), segmental lordosis (SL), anterior disk height (aDH), posterior disk height (pDH), sacral slope (SS), and pelvic tilt (PT). Pelvic incidence (PI=PT+SS) and pelvic incidence minus lumbar lordosis (PI-LL) were calculated. In addition, the Roussouly classification was determined for each patient. Bivariant and multivariant analyses were performed. Results. Of the 363 patients identified in this study, 96 patients had a fusion after their index decompression surgery. Multivariable analysis identified involvement of L4-L5 level in the decompression [odds ratio (OR)=1.83 (1.09-3.14), P=0.026], increased L5-S1 segmental lordosis [OR=1.08 (1.03-1.13), P=0.001], decreased SS [OR=0.96 (0.93-0.99), P=0.023], and decreased endplate obliquity [OR=0.88 (0.77-0.99), P=0.040] as significant independent predictors of fusion after decompression surgery. Conclusions. This is one of the first studies to assess preoperative sagittal parameters in conjunction with demographic variables to determine predictors of the need for fusion after index decompression. We demonstrated that decompression at L4-L5, greater L5-S1 segmental lordosis, decreased sacral slope, and decreased endplate obliquity were associated with higher rates of fusion after decompression surgery.

KW - decompression surgery

KW - fusion surgery

KW - lumbar lordosis

KW - lumbar spine

KW - sagittal alignment

UR - http://www.scopus.com/inward/record.url?scp=85199856168&partnerID=8YFLogxK

U2 - 10.1097/BRS.0000000000005109

DO - 10.1097/BRS.0000000000005109

M3 - Article

C2 - 39056222

AN - SCOPUS:85199856168

SN - 0362-2436

VL - 49

SP - 1598

EP - 1606

JO - Spine

JF - Spine

IS - 22

ER -

Preoperative Radiographic Predictors of Subsequent Fusion after Lumbar Decompression Surgery

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