Preoperative and Postoperative Segmental and Overall Range of Motion in Patients Undergoing Lumbar Spinal Fusion Using HA-Infused PEEK and HA-Treated Titanium Alloy Interbody Cages

Study design: Retrospective observational radiographic analysis.Objective: Determine how single level lumbar interbody fusion (LIF) alters segmental range of motion (ROM) at adjacent levels and decreases overall ROM.Methods: This study included 54 patients who underwent single-level anterior (ALIF, 39%), thoraco-LIF (TLIF, 26%), posterior LIF (PLIF, 22%), or lateral LIF (LLIF, 13%) (L2-3/L3-4/L4-5/L5-S1: 4%/13%/35%/48%). Segmental ROM from L1-2 to L5-S1 and the overall lumbar ROM (L1-S1) were assessed from preoperative and postoperative flexion-extension radiographs. K-means cluster analysis was used to identify ROM subgroups.Results: The overall L1-S1 ROM decreased 14% (25.5 +/- 20.4 degrees to 22.0 +/- 17.2 degrees, P = .104) postoperatively. ROM at the fusion level decreased 77% (4.8 +/- 5.0 degrees to 1.1 +/- 1.1 degrees, P < .001). Caudal adjacent segment ROM decreased 12% (5.2 +/- 5.7 degrees to 4.6 +/- 4.4 degrees, P = .345) and cranially ROM increased 34% (4.3 +/- 5.0 degrees to 5.7 +/- 5.7 degrees, P = .05). K-cluster analysis identified 3 distinct clusters (P < .05). Cluster 1 lost more ROM and had less improvement in patient-reported outcomes measures (PROMs) than average. Cluster 2 had less ROM loss than average with worse PROMs improvement. Cluster 3 did not have changes in ROM and better improvement in PROMs than average. Successful fusion was verified in 96% of all instrumented segments with >6 months follow-up (ROM <4 degrees).Conclusion: Following single-level L IF, patients should expect a loss of 3.3 degrees, or 14% of overall lumbar motion with increases in ROM of the cranial segment. However, specific clusters of patients exist that experience different relative changes in ROM and PROMs.