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A Surgical Treatment Algorithm for Restoring Pelvic Balance and Health-related Quality of Life in High-grade Lumbosacral Spondylolisthesis: Prospective Multicenter Cohort of 61 Young Patients – Lumbar Fusion

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This article is a retrospective multicenter cohort study that proposes an evidence-based surgical algorithm for achieving normal pelvic balance and optimizing health-related quality of life (HRQoL) in patients with high-grade spondylolisthesis. The study assessed 61 patients with high-grade L5-S1 spondylolisthesis and used classification and regression tree analysis to identify objective criteria associated with pelvic balance and HRQoL after surgery. The results showed that the most important predictor of a postoperative balanced pelvis was a postoperative L5 incidence ≤63.5 degrees. Other factors such as residual slip percentage, performing an L5-S1 posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF), and fusion limited to L5 proximally also impacted the likelihood of achieving a balanced pelvis postoperatively. The study also identified predictors of postoperative HRQoL. Based on these findings, the authors propose a surgical algorithm to achieve normal pelvic balance and optimize HRQoL in patients with high-grade spondylolisthesis

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSIONS: A surgical algorithm is proposed to achieve normal pelvic balance, while optimizing HRQoL. The first step during surgery is to assess L5 incidence and if L5 incidence is <65 degrees, the next step depends on the pelvic balance. With a preoperative balanced pelvis, it is important not to reduce completely the slip percentage by leaving a slip percentage ≥10%. When the preoperative pelvis is unbalanced, a TLIF/PLIF at L5-S1 is recommended to facilitate correcting the angular deformity... Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
Clin Spine Surg. 2023 Jul 19. doi: 10.1097/BSD.0000000000001499. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective multicenter cohort-study.OBJECTIVE: We propose an evidence-based surgical algorithm for achieving normal pelvic balance while optimizing health-related quality of life (HRQoL) in high-grade spondylolisthesis.SUMMARY OF BACKGROUND DATA: The principles of surgical treatment for young patients with high-grade L5-S1 spondylolisthesis remain unclear. There,

Clin Spine Surg. 2023 Jul 19. doi: 10.1097/BSD.0000000000001499. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective multicenter cohort-study.

OBJECTIVE: We propose an evidence-based surgical algorithm for achieving normal pelvic balance while optimizing health-related quality of life (HRQoL) in high-grade spondylolisthesis.

SUMMARY OF BACKGROUND DATA: The principles of surgical treatment for young patients with high-grade L5-S1 spondylolisthesis remain unclear. There is a growing body of evidence supporting the central role of pelvic balance in the postural control and biomechanics of subjects with high-grade spondylolisthesis.

METHODS: This retrospective study assessed a multicenter cohort of 61 patients with high-grade L5-S1 spondylolisthesis. Classification and regression tree analysis was used to identify objective criteria associated with pelvic balance and HRQoL after surgery.

RESULTS: The most important predictor of a postoperative balanced pelvis was a postoperative L5 incidence ≤63.5 degrees. With postoperative L5 incidence ≤63.5 degrees,a residual slip percentage 9% and performing an L5-S1 posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) increased the likelihood of achieving a balanced pelvis postoperatively. When L5 incidence was 63.5 degrees,a balanced pelvis was most likely achieved with fusion limited to L5 proximally, residual slip percentage ≤40%, and residual lumbosacral angle 98 degrees. Predictors of postoperative HRQoL were the preoperative HRQoL score, L5 incidence and slip percentage.

CONCLUSIONS: A surgical algorithm is proposed to achieve normal pelvic balance, while optimizing HRQoL. The first step during surgery is to assess L5 incidence and if L5 incidence is <65 degrees, the next step depends on the pelvic balance. With a preoperative balanced pelvis, it is important not to reduce completely the slip percentage by leaving a slip percentage ≥10%. When the preoperative pelvis is unbalanced, a TLIF/PLIF at L5-S1 is recommended to facilitate correcting the angular deformity at L5-S1. If L5 incidence is ≥65 degrees,a TLIF/PLIF at L5-S1 should be performed to correct the angular deformity at L5-S1, and fusion should ideally end at L5 proximally, in addition to performing gradual reduction of the slip percentage. If fusion up to L4 is required, a lumbosacral angle ≥100 degrees is key.

PMID:37482639 | DOI:10.1097/BSD.0000000000001499

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A Surgical Treatment Algorithm for Restoring Pelvic Balance and Health-related Quality of Life in High-grade Lumbosacral Spondylolisthesis: Prospective Multicenter Cohort of 61 Young Patients

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Clin Spine Surg. 2023 Jul 19. doi: 10.1097/BSD.0000000000001499. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective multicenter cohort-study.OBJECTIVE: We propose an evidence-based surgical algorithm for achieving normal pelvic balance while optimizing health-related quality of life (HRQoL) in high-grade spondylolisthesis.SUMMARY OF BACKGROUND DATA: The principles of surgical treatment for young patients with high-grade L5-S1 spondylolisthesis remain unclear. There

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