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Effect of Sagittal Balance on Risk of Falling after Lateral Lumbar Interbody Fusion Surgery Combined with Posterior Surgery.

 Byung Ho Lee  ;  Jae-Ho Yang  ;  Hak-Sun Kim  ;  Kyung-Soo Suk  ;  Hwan-Mo Lee  ;  Jin-Oh Park  ;  Seong-Hwan Moon 
 Yonsei Medical Journal, Vol.58(6) : 1177-1185, 2017 
Journal Title
 Yonsei Medical Journal 
Issue Date
Accidental Falls/statistics & numerical data* ; Aged ; Aged, 80 and over ; Decompression, Surgical/methods* ; Exercise Test ; Female ; Humans ; Incidence ; Lumbar Vertebrae/diagnostic imaging* ; Lumbar Vertebrae/surgery* ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Postoperative Period ; Postural Balance ; Quality of Life ; Radiography ; Risk ; Spinal Fusion/methods* ; Spinal Stenosis/surgery*
Lumbar spinal stenosis ; actual falls ; lateral lumbar interbody fusion ; outcome ; sagittal balance ; surgery
PURPOSE: To demonstrate the impact of correcting sagittal balance (SB) on functional outcomes of surgical treatment for degenerative spinal disease and actual falls via utilization of new minimally invasive lumbar fusion techniques via a lateral approach. MATERIALS AND METHODS: From November 2011 to March 2015, we enrolled 56 patients who underwent minimally invasive lateral lumbar interbody fusion (LLIF) and matched 112 patients receiving decompression/postero-lateral fusion (PLF) surgery for lumbar spinal stenosis. According to SB status using C7-plumb line-distance (C7PL) and surgery type, patients were divided into three groups: SB PLF, sagittal imbalance (SI) PLF, and LLIF groups. We then compared their outcomes. RESULTS: The mean C7PL was 6.2±13.6 mm in the SB PLF group, 72.9±33.8 mm in the SI PLF group, and 74.8±38.2 mm in the LLIF group preoperatively. Postoperatively, C7PL in only the LLIF group improved significantly (p=0.000). Patients in the LLIF group showed greater improvement in fall-related functional test scores than the SI PLF group (p=0.007 for Alternate-Step test, p=0.032 for Sit-to-Stand test). The average number of postoperative falls was 0.4±0.7 in the SB PLF group, 1.1±1.4 in the SI PLF group, and 0.8±1.0 in the LLIF group (p=0.041). Oswestry Disability Index and the Euro-QoL 5 dimension visual analogue scale scores also showed greater improvements in the LLIF group than in the SI PLF group at postoperative 1 year (p=0.003, 0.016). CONCLUSION: Surgical correction of SI in patients with lumbar spinal stenosis using a combination of minimal invasive LLIF and posterior surgery achieved better surgical outcomes and a lower incidence of actual falls than PLF surgery.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
김학선(Kim, Hak Sun) ORCID logo https://orcid.org/0000-0002-8330-4688
문성환(Moon, Seong Hwan)
박진오(Park, Jin Oh)
석경수(Suk, Kyung Soo) ORCID logo https://orcid.org/0000-0003-0633-2658
양재호(Yang, Jae Ho) ORCID logo https://orcid.org/0000-0001-7421-2805
이환모(Lee, Hwan Mo) ORCID logo https://orcid.org/0000-0002-5405-3832
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