T1 Pelvic Angle in Improvement of Pain in High-Grade Lumbar Spondylolisthesis

Abstract

Objective To evaluate the correlation between global sagittal alignment variables and pain improvement after surgery for High-Grade Spondylolisthesis (HGS). Methods A sample with 20 patients with L5-S1 HGS, submitted to arthrodesis with instrumentation from 01/2004 to 12/2016. Patients’ demographic data, types of surgeries, complications, sagittal alignment parameters, and Visual Analog Scale (VAS) score (ranging from 0 to 4) were recorded before surgery and at the last follow-up. The data were processed in SPSS 22.0. The confidence level was 0.05. Results The majority of the sample were women, 17 (85%); age at surgery: 52.60 ± 17.15 years; mean follow-up: 3.58 ± 1.62 years; isthmic etiology, 16 (80%) and dysplastic, 4 (20%); Meyerding Grading 3: 12 (60%), Grading 4: 3 (15%) and Grading 5: 5 (25%); SDSG type 4: 6 (30%), type 5a: 3 (15%), 5b: 3 (15%), type 6: 7 (35%) and not classified 1 (5%); surgery: in situ fusion 3 (15%) and reduction 17 (85%); fusion levels: L3-S1: 1 (5%), L3-Iliac: 1 (5%), L4-S1: 1 (5%), L4-Iliac: 6 (30%) and L5-S1: 11 (55%). Comparing the pre- and postoperative parameters, a significant improvement (p <0.05) was seen in the VAS, T1 slope, T1 pelvic angle (TPA), slip angle, Dubousset’s lumbosacral angle and slip %. Evaluating the correlation between the variation in sagittal parameters and the improvement in VAS scale, it was found that the TPA showed a strong correlation (r = 0.709, p = 0.032). Conclusions the present study found a strong correlation between the improvement/reduction in TPA values and the reduction in pain intensity in the VAS. Level of evidence IV; Case Series.

Melhora da dor radicular após discectomia lombar transforaminal endoscópica em discos com alterações degenerativas avançadas

“…The selected patients were investigated for demographic data, surgical indications, and operative details registered in medical records, as well as pre- and postoperative evaluation by the visual analogue scale (VAS) (varying from 0 to 10, with 0 corresponding to no pain and 10 to the worst pain ever experienced in the leg), where an improvement of 2 points was considered as good clinical result. 6 7 …”

“…► ciática ► deslocamento do disco intervertebral ► região lombossacral medical records, as well as pre-and postoperative evaluation by the visual analogue scale (VAS) (varying from 0 to 10, with 0 corresponding to no pain and 10 to the worst pain ever experienced in the leg), where an improvement of 2 points was considered as good clinical result. 6,7 The radiological parameters (Pfirrmann and Modic classification) were evaluated by experienced radiologist specialized in spine diseases, without access to the clinical features of the patients.…”

“…Os pacientes selecionados foram investigados quanto aos dados demográficos, às indicações cirúrgicas e aos detalhes cirúrgicos registrados nos prontuários, assim como ao registro pré- e pós-operatório da escala visual analógica (EVA) (variando de 0 a 10, sendo 0 sem dor e 10 a dor mais intensa já experimentada na perna), onde a melhora em 2 pontos foi considerada como um bom resultado clínico. 6 7 …”

“…Os pacientes selecionados foram investigados quanto aos dados demográficos, às indicações cirúrgicas e aos detalhes cirúrgicos registrados nos prontuários, assim como ao registro pré-e pós-operatório da escala visual analógica (EVA) (variando de 0 a 10, sendo 0 sem dor e 10 a dor mais intensa já experimentada na perna), onde a melhora em 2 pontos foi considerada como um bom resultado clínico. 6,7 Os parâmetros radiológicos (classificações de Pfirrmann e Modic) foram realizados por um radiologista experiente especializado em doenças da coluna vertebral, sem acesso às características clínicas do paciente.…”