Objective: To analyze the clinical and radiological evolution, indications and complications of the types of osteotomies in patients with disturbed sagittal balance (SB) resulting from post-traumatic kyphosis. The SB can be measured with a plumb line from the center of the body of C7 to S1, which allows recognizing the misalignment. The imbalance can be corrected by osteotomy. Methods: Thirty patients with SB loss due to post-traumatic kyphosis were studied from January 2014 to December 2017. SPO, PSO and VCR were performed to evaluate the degree of kyphosis before and after surgery, the Oswestry questionnaire was applied and the degree of correction, the days of hospital stay and transoperative bleeding were assessed. Results: Age, 50 years, SD = 14, follow-up time: 2-3 years. We performed 11 (36.7%) osteotomies of S-P, 17 (56.7%) pedicle subtractions and 2 (6.6%) vertebrectomies. Most of the lesions were found between levels L1 and L2; the complications were dehiscence of the surgical wound in 4 patients (13.3%) and infection in 2 (6.6%). The minimum surgical time was 3 hours; the Oswestry questionnaire did not showed statistically significant difference during the preoperative period, however, considerable improvement was observed 2 years after surgery. Conclusions: The use of corrective vertebral osteotomies significantly re-establishes the spinopelvic balance altered by different pathologies. It allows correcting in a single surgery the sagittal balance, achieving corrections from 10° to 40°, depending on the type of osteotomy performed, being a safe and effective procedure, which allows to restore the spinopelvic balance, improving the quality of life of the patients. Level of Evidence IIb; Prospective cohort study.
Introducción: La espondilolistesis es el deslizamiento de una vértebra sobre otra subyacente. El nivel que se afecta con más frecuencia (73%) es el correspondiente a L4-L5. Los tratamientos van desde el conservador hasta la fusión posterolateral con fijación con tornillos transpediculares con espaciadores intersomáticos. El equilibrio espinopélvico es determinado por la interacción o alineamiento de la pelvis y la columna lumbar, por lo que el desequilibrio espinopélvico es un factor importante en el desarrollo de esta patología. Objetivo: Valorar la modificación del balance sagital con la colocación de tornillo al sacro (S1) en la espondilolistesis L4-L5. Material y métodos: Se incluyeron pacientes del Servicio de Columna, con diagnóstico de espondilolistesis de L4-L5, con instrumentación vertebral lumbar o lumbosacra. Se realizó estudio radiológico pre-y postquirúrgico para valorar el balance sagital y la aplicación del test de Oswestry de calidad de vida, pre-y postquirúrgico (cero, tres y seis meses). Resultados: Se realizaron 11 cirugías en pacientes con diagnóstico de espondilolistesis de L4-L5. A 27% se instrumentó hasta el sacro, al resto se instrumentó L4-L5; se realizó análisis estadístico, el cual reportó que el uso del tornillo transpedicular a S1 mejora el balance sagital de la lordosis lumbar, la incidencia e inclinación pélvica. Conclusión: El uso del tornillo pedicular a nivel de S1 en el tratamiento de espondilolistesis L4-L5 mejora el equilibrio sagital espinopélvico, ya que actúa como fulcro para la corrección de la lordosis lumbar e inclinación sacra, al obtener un buen balance sagital se obtienen mejores resultados clínicos.
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