gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Looking at global and segmental lordotic realignment in 104 patients with lytic spondylolisthesis: TLIF versus posterior-anterior-posterior procedure

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  • R. Klavora - Wirbelsäulenchirurgie, Neurotraumatologie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad
  • T. Pitzen - Wirbelsäulenchirurgie, Neurotraumatologie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad
  • N. Matis - Wirbelsäulenchirurgie, Neurotraumatologie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad
  • G. Ostorwski - Wirbelsäulenchirurgie, Neurotraumatologie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad
  • J. Harms - Wirbelsäulenchirurgie, Neurotraumatologie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocSA.08.07

doi: 10.3205/12dgnc358, urn:nbn:de:0183-12dgnc3586

Published: June 4, 2012

© 2012 Klavora et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: Lumbar sagittal profile is severely influenced in spondylolisthesis by the anterior slippage of L5 versus S1. One of the goals of surgical treatment of lytic spondylolisthesis – to be performed via TLIF or combined Posterior-Anterior-Posterior procedures (PAP) – is correction of the lumbar sagittal profile. The objective of the current study was to investigate, if the lumbar sagittal profile following surgical treatment of lytic spondylolisthesis is improved and if it significantly depends on the surgical approach.

Methods: This is a retrospective radiographic study. Measurements were performed by an independent reviewer. Digitised (Spineview 2.4, Surgiview, Paris, France) radiographs (pre- and early postoperative lateral x-rays of the lumbar spine) of 104 individuals, surgically treated for lytic spondylolisthesis L5–S1 in one single center were used. 72 patients were treated by combined PAP, 32 via TLIF. We checked lordosis between L1–S1, L5–S1 and sacral slope in each individual both pre – and early postoperative.

Research questions were as follows: 1: Can were improve sagittal alignment by surgical procedures? 2: If yes, which procedure results in better correction?

Statistics were performed using an SPSS software package by an independent researcher, significance was assumed for p<0.05.

Results: TLIF procedure: Lordosis L5–S1: pre 7° and postop 10° (p=0.03), Lordosis L1–S1 pre 59° and postop 51° (p=0.001), Sacral slope: pre 46° and postop 42° (p=0.001), Wilcoxon Rank. PAP procedure: Lordosis L5–S1: pre 6° and postop 16° (p<0,0001), Lordosis L1–S1: pre 65° and postop 59° (p<0,001), Sacral slope: pre 49° and postop 47° (p=0.011), Wilcoxon Rank. TLIF versus PAP: There is a significant change in each of the parameters described, with more lordotic alignment received by PAP procedures (p<0.0001), Mann-Whitney-U-Test).

Conclusions: 1: Segmental L5–S1 lordosis can be performed via TLIF or via PAP procedures in patients suffering lytic spondylolisthesis. Global lordosis, however, is reduced in both procedures. This may be due to compensation following segmental lordotic realignment, or due to early postop pain 2: The degree of segmental lordosis L5–S1 obtained is significantly more pronounced in PAP procedures.