文献类型：期刊文献

英文题名："The protective buffer": Adequate L4-S1 lordosis restoration reduces the symptomatic conversion of radiographic ASD and long-term revision rates - A 5-year multicenter cohort study

作者：Wang, Chen[1];Dong, Zhifeng[3];Jia, Jing[1];Zhang, GuangYi[1];Fan, Xirong[1];Zhang, Kai[5];Xue, Wen[2];Wang, Qilong[1];Wang, Zeng Ping[2];Lei, ShuanHu[4]

第一作者：Wang, Chen

通信作者：Xue, W[1]

机构：[1]Gansu Univ Chinese Med, Gansu Prov Hosp, Clin Med Coll 1, Lanzhou 730000, Gansu, Peoples R China;[2]Gansu Prov Hosp, Lanzhou, Gansu, Peoples R China;[3]Second People Hosp Tianshui, Tianshui, Gansu, Peoples R China;[4]Lanzhou Univ, Hosp 2, Lanzhou, Gansu, Peoples R China;[5]Second Peoples Hosp Gansu Prov, Lanzhou 730000, Gansu, Peoples R China

第一机构：甘肃中医药大学

通信机构：[1]corresponding author), Gansu Prov Hosp, Lanzhou, Gansu, Peoples R China.

年份：2026

外文期刊名：EUROPEAN SPINE JOURNAL

收录：;Scopus(收录号：2-s2.0-105046214689);WOS:【SCI-EXPANDED(收录号:WOS:001836694000001)】；

基金：The authors kindly acknowledge all the patients involved in this study for their willingness to share their medical data and for their cooperation throughout the research process.

语种：英文

外文关键词：L4-S1 segmental lordosis; Adjacent segment disease (ASD); Symptomatic conversion rate; Revision surgery; Pelvic tilt; TLIF

摘要：Background Inadequate restoration of L4-S1 segmental lordosis (SL) is a recognized contributor to adjacent segment disease (ASD). However, evidence regarding its impact on long-term revision rates remains conflicting, primarily due to short follow-up periods that fail to capture the critical transition from radiographic degeneration to symptomatic disease. Purpose To evaluate the 5-year impact of L4-S1 SL restoration on revision rates and to introduce the concept of "Symptomatic Conversion Rate" to quantify the clinical progression of ASD. Study Design A multicenter, retrospective cohort study. Patient Sample A total of 232 patients who underwent L4-S1 transforaminal lumbar interbody fusion (TLIF) with a minimum 5-year follow-up were included. The cohort was stratified into Adequate and Inadequate Restoration groups based on postoperative L4-S1 SL. Outcome Measures The primary endpoint was the 5-year revision surgery rate. Secondary endpoints included radiographic parameters (pelvic tilt [PT], pelvic incidence-lumbar lordosis [PI-LL] mismatch), implant failure rates, and patient-reported outcome measures (Oswestry Disability Index [ODI], Visual Analog Scale [VAS]). The "Symptomatic Conversion Rate" (the percentage of patients with radiographic ASD progressing to symptomatic ASD) was also assessed. Methods Clinical and radiographic data collected at a minimum of 5 years postoperatively were retrospectively analyzed. The cohorts were compared to assess the influence of L4-S1 SL restoration on long-term survivorship, functional recovery, and ASD progression. Results Baseline demographics and PI were comparable between groups (P > 0.05). At the 5-year follow-up, the Inadequate Group exhibited significant pelvic retroversion (PT increased to 21.82 degrees vs. 17.26 degrees in the Adequate Group, P < 0.001). Although radiographic ASD was prevalent in both cohorts (58.1% vs. 38.1%), the Symptomatic Conversion Rate was markedly higher in the Inadequate Group (73.3% vs. 28.1%, P < 0.001). Consequently, the 5-year revision rate was significantly greater in the Inadequate Group (26.4% vs. 2.4%, P < 0.001). The Inadequate Group also demonstrated inferior ODI scores (28.5 vs. 14.2, P < 0.001) and an increased incidence of screw loosening. Conclusions Inadequate L4-S1 SL restoration is an independent risk factor for long-term revision surgery and implant failure following TLIF. Precise restoration provides a crucial "biomechanical buffer," preventing compensatory pelvic retroversion and significantly reducing the conversion of radiographic ASD into symptomatic disease. Achieving this protective buffer should be a primary surgical objective to maximize long-term construct survivorship.