Artikel
Effect of mono- or bisegmental lordosizing fixation on short-term global and index sagittal balance: a radiographic study
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Autoren
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Ilaria Melloni
- IRCCS Azienda Ospedaliera Universitaria San Martino-IST, U.O.C. Clinica Neurochirurgica e Neurotraumatologica, Genova, Italia
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Oliver P. Gautschi
- Hopitaux Universitares de Genève, Service de Neurochirurgie, Genève, Suisse
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Karl Schaller
- Hopitaux Universitares de Genève, Service de Neurochirurgie, Genève, Suisse
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Enrico Tessitore
- Hopitaux Universitares de Genève, Service de Neurochirurgie, Genève, Suisse
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
Text
Objective: Sagittal balance is widely recognized as a major outcome factor in reconstructive spinal surgery for degenerative spine disease. However, long fixations performed in order to restore sagittal balance have high morbidity. Therefore, the aim of this study was to evaluate the preoperative and short-term postoperative spino-pelvic balance after short lordosizing lumbar fixation (1 or 2 levels) in order to assess if a minor spinal reconstructive surgery is able to influence global spinal alignment.
Method: 26 consecutive patients (13 males, 13 females, mean age 62,8 years ± 15,2) who underwent mono- or bisegmental lordosizing lumbar fusion (XLIF/TLIF) for degenerative spine disease were included in the study. Clinical parameters were retrospectively collected from charts. Pre- and postoperative (6 weeks-3 months) full-spine EOS (low-dose, biplanar X-ray imaging, EOS imaging, Paris, France) were evaluated. Spinal parameters concerning sagittal curvatures, pelvic orientation, global sagittal and coronal alignment, spino-pelvic balance, index level segmental lordosis and disc height were measured. Statistical analysis was performed with paired samples two-tailed t tests.
Results: Preoperative clinical assessment included Charlson Comorbidity Index (mean 3,3 ± 1,9) and ASA score (1 in 2 cases, 2 in 20 cases, 3 in 4 cases). 34 segments were fused (12 XLIF, 22 TLIF) in 26 patients (18 mono- and 8 bisegmental fixations). 7 (26,9%) patients presented preoperative sagittal imbalance (SVA >50 mm), 7 patients preoperative severe pelvic retroversion (PT>20°), and one patient had both. Disc height, intervertebral angle and segmental lordosis at the operated level increased significantly after surgery (p<0,01). No postoperative significant change in global sagittal alignment (SVA, TPA, T1SPi, T9SPi), pelvic orientation (SS, PT), coronal alignment, lumbar and L4-S1 lordosis and thoracic kyphosis was found.
Conclusions: Mono- and bisegmental fixations are able to restore disc height and to improve segmental lordosis, however, they do not allow either restoration of sagittal balance or change in pelvic orientation or in spinal curves. A limited spinal reconstructive surgery on symptomatic levels can be reasonably proposed to patients with hidden or evident sagittal imbalance without expecting modification of spino-pelvic alignment as a goal of surgery.
