Do Spinopelvic Parameters Matter in Short-Segment Posterior Lumbar Spinal Fusions? A Meta-Analysis

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Conference Proceeding

Publication Date


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Brain & Spine


Background: Restoration of sagittal balance has been associated with better clinical outcome in spinal deformity. However its implications on short-segment lumbar spinal fusion for degenerative spine disease remains unknown. In this study we sought to determine the association between adjacent segment disease (ASD) and spinopelvic parameters in short-segment posterior lumbar spinal fusion.

Methods: With adherence to PRISMA guideline, comprehensive database searches were conducted to identify studies that evaluate ASD with spinopelvic parameters in short-segment lumbar fusion. SD was defined as radiographic and symptomatic axial pain or radiculopathy at adjacent level following index surgery. Independent reviewers extracted data and assessed the outcome. A meta-analysis using random effect weight mean difference model (WMD) was constructed.

Results: A total of 13 studies comprising of 1853 patients underwent 1-3 levels posterior lumbar fusion for degenerative spondylisthesis and spinal stenosis. Of these, 393 patients developed ASD following index surgery while the rest of the patients serve as control. Both groups had comparable basic demographic features in term of age, gender, and BMI. Preoperatively, there were significantly higher pelvic incidence-lumbar lordosis(PI-LL) mismatch in ASD group (p=0.02) and higher pelvic tilt (p=0.01). Interestingly, preop lumbar lordosis (LL) was not observed to be associated with ASD along with pelvic tilt(PT), pelvic incidence(PI), sagittal vertical axis(SVA). However postoperatively, significant loss of LL was then observed in ASD group (p=0.0001) along with much higher PI-LL mismatch (p=0.04). A subgroup analysis of patients with ASD who eventually treated with surgery was again revealing significant higher pre- &post-op PI-LL, low postop LL.

Conclusions: This study demonstrated that the relation of pelvis to spine is critical in treating patients with degenerative lumbar spine disease. Failure to correct or progression of PI-LL mismatch were significantly associated with ASD with posterior lumbar spinal fusion even in short-segment constructs.




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EANS 2023 European Association of Neurosurgical Societies Congress, September 24-28, 2023, Barcelona, Spain