Article Figures & Data
Figures
- Figure 1
Personalized lumbar interbody devices for anterior lumbar interbody fusion, lateral lumbar interbody fusion, and transforaminal lumbar interbody fusion.
- Figure 2
Radiographic sagittal alignment measurements for 67 study patients. Mean postoperative pelvic incidence minus lumbar lordosis (PI−LL) and T1 pelvic angle (T1PA) were significantly reduced compared with preoperative measurements.
- Figure 3
Pre- vs postoperative sum of SRS-Schwab modifiers and component SRS-modifiers (mean ± SD). The postoperative change (delta) in pelvic incidence minus lumbar lordosis (PI−LL) modifier has the strongest correlation to the change in the sum of modifiers.
- Figure 4
Pre- vs postoperative patient distributions of SRS-Schwab component modifiers and sum of modifiers. Data presented are the percentage of patients.
- Figure 5
Distribution of patients according to directional postoperative changes in sagittal SRS-Schwab alignment modifier scores for pelvic incidence minus lumbar lordosis (PI−LL), pelvic tilt (PT), and T1 pelvic angle (T1PA). Data presented are the percentage of patients with improved, maintained, or worsened postoperative modifier scores.
- Figure 6
Postoperative changes in magnitude and direction of summed modifiers for 67 study patients.
- Figure 7
Contribution of segmental corrections to changes in lumbar lordosis for 67 study patients (A). Lumbar lordosis is the sum of segmental lordosis angles between L1 and S1 (B). “Other Levels” include (a) levels with posterior instrumentation and fusion only, (b) levels treated with nonpersonalized interbody devices, and (c) levels not treated.
- Figure 8
Baseline and 6-month radiographs of a 77-year-old man who underwent L2–S1 posterolateral fusion with lateral lumbar interbody fusion (LLIF) interbody devices at L3–L5.
- Figure 9
Baseline and 6-month radiographs of a 59-year-old man who underwent L5–S1 transforaminal lumbar interbody fusion (TLIF) and posterolateral fusion from T4 to the pelvis.
Tables
- Table 1
Definitions for SRS-Schwab modifiers and severity thresholds for sagittal deformity.
Severity of Deformity SRS-Schwab Modifier Modifier Threshold Values PI−LL PT T1PA (SVA surrogate) Mild/none 0 <10° <20° <10° Moderate + 10°–20° 20°–30° 10°–20° Severe ++ >20° >30° >20° Abbreviations: PI−LL, pelvic incidence minus lumbar lordosis; PT, pelvic tilt; SVA, sagittal vertical axis; T1PA, T1 pelvic angle.
Deformity Severity Sum of SRS-Schwab Modifiers Mild/none 0 to 1+ Moderate 2+ to 3+ Marked/severe 4+ to 6+ - Table 3
Demographics, spine surgery history, and preoperative radiographic parameters of the study population.
Variable Value Demographics N 67 Sex, women, n (%) 47 (70.1) Age, y, mean (SD) 66.2 (10.1) BMI, mean (SD) 28.6 (5.7) Previous spine surgery Total, n (%) 34 (50.7) With instrumentation, n (%) 29 (43.3) Previous instrumented fusion levels, median (range) 2 (1, 14) Preoperative radiographic sagittal alignment parameters PI−LL mismatch, degrees, mean (SD) 21.0 (16.2) PT, degrees, mean (SD) 23.8 (8.6) T1PA, degrees, mean (SD) 25.0 (10.1) Abbreviations: BMI, body mass index; PI−LL, pelvic incidence minus lumbar lordosis; PT, pelvic tilt; T1PA, T1 pelvic angle.
Operative Parameters Value Time since surgery, mo, median (range) 14.7 (3.9, 39.2) Instrumented vertebrae during surgery, median (range) 9 (4, 18) Personalized interbody devices implanted, median (range) 2 (1, 5) Cases treated with implant type(s), n (%) ALIF 14 (20.9%) ALIF, LLIF 10 (14.9%) LLIF 14 (20.9%) TLIF 29 (43.3%) UIV, n (%) T1 1 (1.5%) T2 4 (6%) T3 3 (4.5%) T4 9 (13.4%) T5 2 (3%) T8 1 (1.5%) T9 13 (19.4%) T10 24 (35.8%) L1 2 (3%) L2 8 (11.9%) LIV, n (%) L2 2 (3%) L5 2 (3%) S1 23 (34.3%) Pelvis 40 (59.7%) Abbreviations: ALIF, anterior lumbar interbody fusion; LIV, lower instrumented vertebra; LLIF, lateral lumbar interbody fusion; TLIF, transforaminal lumbar interbody fusion; UIV, upper instrumented vertebra.
Category ≤90 d Postoperatively >90 d Postoperative Patients, n (%) No. of Events Patients, n (%) No. of Events Medical AE 6 (9%) 8 3 (4%) 4 Medical complication (SAE) 2 (3%) 2a 0 0 Surgical AE 6 (9%) 9 1 (1.5%) 1b Surgical complication (SAE) Prolonged surgery/recovery 8 (12%) 8c 0 0 Reoperation 2 (3%) 2d 1 (1.5%) 1e Abbreviations: AE, adverse event; DVT, deep vein thrombosis; PJK, proximal junctional kyphosis; SAE, serious adverse event.
Note: None of reported AEs or complications were related to personalized interbody devices.
↵a Postoperative DVT (2).
↵b Adjacent segment disease treated nonoperatively, 18 months postoperatively (1).
↵c Vascular injury (2), dural tear (2), pneumothorax (1), anemia (1), seroma (1), and lymphocele (1).
↵d Screw malposition or loosening (2).
↵e Mechanical complication: adjacent segment disease with PJK (1), reoperation 9 months postoperatively.
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