Poster Presentation 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

Introduction: Patients scheduled for L4−5 PLIF often have FS at L5-S1. However, data on the clinical and radiographic outcomes of cases with mild-to-moderate L5−S1 FS are lacking, which may affect clinical outcomes or require additional surgery after L4−5 fusion. To compare the clinical and radiographic outcomes after posterior lumbar interbody fusion (PLIF) at L4−5 in patients with lumbar degenerative diseases with or without mild-to-moderate foraminal stenosis (FS) at L5−S1.

Methods: A retrospective review of lumbar degenerative disease patients who underwent L4−5 PLIF from 2014 to 2018. The patients were divided according to the presence of mild-to-moderate FS at L5−S1. Clinical assessment included the pain visual analog scale (VAS), Oswestry Disability Index (ODI), and the EuroQol 5-Dimension (EQ-5D) score. Radiographic assessments included spinopelvic parameters and grades for central and foraminal stenosis. Clinical outcomes were assessed using validated outcome measures at preoperative, 6-month, 12-month, and 36-month follow-up visits. Radiographic evaluations were performed using preoperative and postoperative radiographs, CT, and MRI.

Results: Of a total of 186 patients, 55 were categorized as the FS group and 131 as the non-FS group. The FS group was older (P=0.039) and had more severe central stenosis at L5−S1 (P=0.007) as well as more severe FS at both L4−5 and L5−S1 (both P<0.001). Preoperative disc height (P<0.001), C7-S1 sagittal vertical axis (P=0.003), lumbar lordosis (P=0.005), and pelvic incidence–lumbar lordosis mismatch (P=0.026) were more aggravated in the FS group. The FS group showed inferior clinical outcomes at the final follow-up in terms of back pain (P=0.010) and ODI score (P=0.003).  

Conclusion: The presence of mild-to-moderate FS at L5–S1 was associated with more aggravated sagittal balance in terms of smaller preoperative disc height, larger sagittal vertical axis, smaller lumbar lordosis, and larger pelvic incidence–lumbar lordosis mismatch. Patients with L5−S1 FS also had poorer clinical outcomes including back pain and ODI score after L4−5 PLIF. Patients with L5−S1 FS need to be carefully examined before L4−5 fusion considering their adverse outcomes due to underlying degenerative changes.