Article
Influence of relordosing mono-and bisegmental TLIF-Spondylodesis on spino-pelvic malalignment
Search Medline for
Authors
-
Frederick Galla
- Orthopädische Klinik II - Wirbelsäulenchirurgie, Münster, Deutschland
-
Dirk Waehnert
- Universitätsklinikum Münster, Münster, Deutschland
-
Ulf Liljenqvist
- Orthopädische Klinik II - Wirbelsäulenchirurgie, Münster, Deutschland
| Published: | June 18, 2018 |
|---|
Outline
Text
Objective: The main spinopelvic parameters of lumbar lordosis (LL) and pelvic incidence (PI) have high clinical relevance. In the literature a mismatch of LL and PI has been described to be associated with higher rates of proximal segment degeneration and of postop. revisions and inferior clinical outcome. The aim of this retrospective, radiological study is to evaluate the influencing factors and the possible extent of relordosing in mono-/bisegm. TLIF.
Methods: In 2016 mono- (n=115, G1) and bisegm. (n=49, G2) TLIF were performed in 164 pat. for different indications. Radiologic parameters with pelvic incidence, lumbar lordosis (preop., postop. and 3 months postop.), implementation of additional Smith-Peterson osteotomies, implanted cage-sizes were evaluated retrospectively. Depending on their match of LL/PI the pat. were categorised into three groups (LL-PI <10° green, LL-PI 10-20° yellow, LL-PI > 20° red). Further surgeons were distinguished by their spinal-surgery experience with more or less than ten years of performing TLIF .
Results: A mismatch of 10-20° (yellow) between LL/PI was seen in 29.6% in G1 and in 38.8% in G2. 29.6% of pat. in G1 and 16.3% in G2 showed an absolut preop. spino-pelvic mismatch of >20° (red). By performing relordosing TLIF a significant correction of LL was possible (p<0.05). This facilitated an increase of patients with a balanced sagittal alignment (green) from 40.9% preop. to 70.4% postop. in G1 and from 44.9% to 85.7% in G2 (p<0.05). The rate of pat. with an absolute preop. mismatch (red) could be reduced in G1 from 29.6% to 13.9% and in G2 from 16.3% to 2% postop. (p<0.05). In G1 an correction of the LL was possible from 46.3° to 53.8° (yellow) and 35.7° to 45.8° (red), while in G2 the LL could be corrected from 43.4° to 51.5° (yellow) and 36.6° to 50.1° (red) (p<0,05). Monosegmental higher cages lead to a better match of LL/PI (p< 0.05). Experienced surgeons accomplished more osteotomies and had significant higher postop. matches of LL/PI (p<0.05).
Conclusion: The study was able to show that a significant correction of the spino-pelvic alignment by applying relordosing mono-/bisegm. TLIF-Spondylodesis is possible. Concluding we can state that in lumbar fusion surgery the ratio of LL/PI should be observed preoperatively to influence the restoration of lumbar lordosis to the best possible extent.
