Georg Schmorl Prize of the German Backbone Society (DWG) 2017: correction of spino-pelvic alignment with relordosing mono- and bisegmental TLIF spondylodesis.
Eur Backbone J. 2018 Feb 07;:
Authors: Galla F, Wähnert D, Liljenqvist U
INTRODUCTION: A balanced ratio of the primary parameters of lumbar lordosis (LL) and pelvic incidence (PI) has excessive scientific relevance. A postoperative mismatch of LL and PI has been described within the literature to be related to an inferior scientific end result and better postoperative revision charges. The goal of this retrospective, radiological examine is to guage the magnitude of relordosing in mono-/bisegmental TLIF spondylodesis affecting the spino-pelvic alignment and the primary contributing components.
MATERIALS AND METHODS: 164 sufferers (pat.) underwent monosegmental (n = 115, G1) and bisegmental (n = 49, G2) TLIF spondylodesis, respectively, for various indications in 2016 in our hospital. Pelvic incidence, lumbar lordosis (preop., postop., Three months postop.), implanted cage sizes, and using further Smith-Petersen osteotomies had been analysed retrospectively. Sufferers had been divided into three teams relying on match of LL/PI (PI-LL < 10° inexperienced, PI-LL = 10-20° yellow, PI-LL > 20° purple). Moreover, a differentiation was made between surgeons with greater than or lower than 10 years of spinal surgical procedure expertise, respectively.
RESULTS: 29.6% of pat. in G1 and 16.Three% in G2 confirmed a extremely pronounced preoperative spino-pelvic mismatch (purple). A excessive grade of mismatch (yellow) between LL/PI was seen in 29.6% in G1 and in 38.eight% in G2. The remaining sufferers already had a balanced ratio of LL/PI (inexperienced). Via relordosing TLIF the LL might be corrected considerably (p < zero.05). Due to this fact, the variety of sufferers with a balanced sagittal alignment (inexperienced) elevated from 40.9% preop. to 70.four% postoperative in G1 and from 44.9 to 85.7% in G2 (p < zero.05). The variety of pat. with extremely pronounced preoperative mismatch (purple) might be lowered in G1 from 29.6 to 13.9% and in G2 from 16.Three to 2% postoperative (p < zero.05). In G1, the preoperative LL might be corrected from 46.Three° to 53.eight° (yellow) and 35.7° to 45.eight° (purple), whereas in G2, a correction was attainable from 43.four° to 51.5° (yellow) and 36.6° to 50.1° (purple) (p < zero.05). No important distinction of segmental/full LL was discovered between radiologic measurement instantly postoperative and on the Three-month follow-up. In monosegmental fusion larger cages sizes result in a greater match of LL/PI (p < zero.05). The precise cage lordosis (5° vs. 10°) had no affect on the extent of relordosing. Skilled surgeons had important larger postoperative matches of LL/PI (p < zero.05) and completed extra osteotomies (p < zero.05).
DISCUSSION: This retrospective examine demonstrates that important relordosing and, subsequently, correction of the spino-pelvic alignment are attainable with mono-/bisegmental TLIF spondylodesis. Optimistic affect of upper cage sizes and surgeon’s expertise was proven. We conclude that the ratio of LL/PI must be taken into consideration preoperatively in lumbar fusion surgical procedure when planning mono-/bisegmental TLIF spondylodesis to optimize spino-pelvic alignment. These slides may be retrieved below Digital Supplementary Materials.
PMID: 29417323 [PubMed – as supplied by publisher]