Correlation between direction of pedicle screw and restoration of lumbar degenerative scoliosis in degenerative lumbar spondylolisthesis: a retrospective study

Xuqiang Zhan; Xinhua Zhan; Jili Yu; Gregory Moore; Fuping Li; Xin Xi; Zhili Zeng; Shaomeng Yin; Yan Yu; Liming Cheng

doi:10.21037/qims-22-483

Correlation between direction of pedicle screw and restoration of lumbar degenerative scoliosis in degenerative lumbar spondylolisthesis: a retrospective study

Quant Imaging Med Surg. 2023 Mar 1;13(3):1740-1752. doi: 10.21037/qims-22-483. Epub 2023 Jan 12.

Authors

Xuqiang Zhan^#^{1

2}, Xinhua Zhan^#³, Jili Yu^#⁴, Gregory Moore⁵, Fuping Li^{1

6}, Xin Xi^{1

2}, Zhili Zeng^{1

2}, Shaomeng Yin⁷, Yan Yu^{1

2}, Liming Cheng^{1

2}

Affiliations

¹ Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
² Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Department of Spine Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
³ Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
⁵ Weill Cornell Medical College, New York, NY, USA.
⁶ Department of Spine Surgery, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China.
⁷ Meitan Jiali Hospital, Zunyi, China.

^# Contributed equally.

Abstract

Background: Inferior clinical outcomes have been reported in patients with degenerative lumbar spondylolisthesis (DLS) accompanied by lumbar degenerative scoliosis, but little attention has been paid to its radiologic assessment or preoperative planning. The aim of this study was to analyze the effect of transforaminal lumbar interbody fusion on patients with DLS and lumbar degenerative scoliosis and explore the surgical aspects benefiting the restoration of lumbar degenerative scoliosis.

Methods: All patients with DLS and lumbar degenerative scoliosis undergoing single-level unilateral transforaminal lumbar interbody fusion surgery between July 1, 2015, and April 30, 2021, were screened in this retrospective cohort study. Clinical outcomes including visual analog scale (VAS), Oswestry disability index (ODI), and radiographic parameters of sagittal and coronal alignment, cage spatial locations, and angle of pedicle screw (parallel, cranial, and caudad angle) were assessed. Coronal asymmetry was demonstrated by the intervertebral height difference between the medial and lateral margins of indexed intersegmental space. The correlations between Δintervertebral height difference (postoperative intervertebral height difference-preoperative intervertebral height difference) and radiographic parameters and clinical outcomes were analyzed by univariable, multivariable, mediation, and correlation analyses. Significance was set at a bilateral P<0.05.

Results: A total of 57 included patients were followed up for a minimum of 1 year. Reduction of VAS, ODI, and improvement of radiographic parameters were found after surgery. The cranial angle of the lower pedicle screw positively correlated with Δintervertebral height difference restoration (b=0.54; standard error=0.11; P<0.001).

Conclusions: Transforaminal lumbar interbody fusion surgery appears to be an effective approach to improving the radiographic and clinical outcomes of patients with DLS and lumbar degenerative scoliosis. The cranial direction of the lower pedicle screws in single-level unilateral transforaminal lumbar interbody fusion surgery may be associated with a better postoperative restoration of lumbar degenerative scoliosis.

Keywords: Degenerative lumbar spondylolisthesis (DLS); direction of pedicle screw; lumbar degenerative scoliosis; transforaminal lumbar interbody fusion (TLIF).