Evaluation of lordosis recovery after lumbar arthrodesis and its clinical impact

Background Posterior lumbar arthrodesis has become a widely used therapeutic option to correct sagittal imbalances in patients suffering from degenerative lumbar conditions.However,in western Africa,there is no study have reported long-term outcome of posterior lumbar arthrodesis.The aim of this study was to investigate the relationship between the restoration of adequate lordosis and the patient’s postoperative quality of life.Method The study was retrospective.From January 2012 to December 2019,80 patients who underwent posterior lumbar arthrodesis for lumbar degenerative diseases were included with a mean follow-up of 43.2 months.Mean age was 50.8 years(SD=12.2).Preoperative and postoperative patients'symptoms were assessed by the visual analog scale(VAS),Oswestry Disability Index(ODI),and 12-item Short Form(SF-12).Pre-and post-operative radiographic evaluation included lumbar lordosis measured(LLm),pelvic incidence(PI),sacral slope(SS),and pelvic stilt(PS).Theoretical lumbar lordosis(LLt)was defined by the following:LL=0.54×PI+27.6.Data analysis was done using the statistical software"R."The risk of error was 5%(p<0.05).Result The mean pelvic incidence was 57.23°.There was no statistically significant difference between preoperative and postoperative lumbar lordosis(p=0.2567).There was no statistical difference between preoperative and post-operative PI-LL(p=0.179).There was a statistically significant difference between the pre and postoperative clinical scores(p<0.001).Statistical analysis showed a correlation between recovery of lumbar lordosis and improvement in physical component of SF-12(PCS)(p<0.05)and lumbar and radicular VAS(p<0.05)for the subgroup of narrow lumbar spine.There was a statistical relationship between the restoration of lumbar lordosis and improvement in PCS(p=0.004)and VAS(p=0.003)for the subgroup of isthmic lysis spondylolisthesis.Discussion The root decompression performed in most patients could explain the clinical improvement regardless of recovery of lordosis.The failure to consider spinal parameters and sagittal balance of patients in the surgery could explain no restoration of lumbar lordosis.Our study had limitations inherent to its retrospective character such as the classic selection bias.Conclusion Satisfactory correction of spinopelvic alignment may improve long-term clinical signs.

Functional outcome of surgical management of low mid-grade lumbar spondylolisthesis when considering the sagittal balance parameters preoperatively:a prospective study

Background:Prospective study objectives.A sagittal balance is a good tool to improve the functional outcome of spine spondylolisthesis surgeries,primarily noted that it has a good impact in deformity surgery and then applied to every spine surgery and the aim of this study is to evaluate its functional outcome when considered in preoperative planning for non-dysplastic low-and mid-grade spondylolisthesis surgeries.Method:Forty patients diagnosed as low-or mid-grade non-dysplastic spondylolisthesis had undergone surgery at Cairo University after failed medical treatment had been evaluated preoperatively by measuring the sagittal balance parameters which include SVA,spinopelvic angles,lumbar lordosis,pelvic tilt,sacral slope,and pelvic incidence and then measure it along a follow-up period of 1 year postoperatively started from February 2018 and correlate it with functional outcome using Oswestry score(ODI)and VAS.Correction of parameters has been estimated preoperatively by manual estimation and Surgimap application then applied during the operation.Results:All patients were treated by surgical treatment through posterior transpedicular screw fixation with conventional or reduction screws and fusion±TLIF cages.The mean of lumbar lordosis and mean spinopelvic angles were increased in a statistically significant manner.Pelvis tilt was decreased in a statistically insignificant manner.The mean of pelvic incidence was not changed and statistically insignificant,and this is matching the fact that pelvic incidence is a constant parameter.The sacral slope was increased in a statistically insignificant manner.Final results showed that 37 had a statistically significant improvement in their ODI>20%at the last visit.Three patients had a poor clinical outcome with ODI scorFinal results showed that 37 had a statistically significant improvement in their ODI>20%at the last visit.Three patients had a poor clinical outcome with ODI score of>20%improvement,and we noticed that the level of pathology was at the level of L4L5,SVA was positive and worsen postoperatively,and also,it is accompanied by decreased lumbar lordosis.Change in ODI means statistically significant improvement when considering sagittal parameters preoperation and during operation.Conclusion:Sagittal balance parameters should be considered in the surgical management of low-grade spondylolisthesis cases to improve their functional outcome.