Comparative study of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis

Funao, Haruki; Tsuji, Takashi; Hosogane, Naobumi; Watanabe, Kota; Ishii, Ken; Nakamura, Masaya; Chiba, Kazuhiro; Toyama, Yoshiaki; Matsumoto, Morio

doi:10.1007/s00586-012-2374-0

Cited by 107 publications

(86 citation statements)

References 24 publications

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“…[15] изучали исходы хирургического лечения у 42 пациен-тов, оперированных по поводу стеноза поясничного отде-ла позвоночника (25) и нестабильности позвоночно-дви-гательного сегмента (17), которым был выполнен транс-фораминальный межтеловой спондилодез с использова-нием межтеловых имплантатов различных форм. Исполь-зование прямоугольных имплантатов привело к уменьше-нию глобального люмбального лордоза.…”

Section: вопросы нейрохирургии 5 2015unclassified

“…Funao и соавт. [17] изучили параметры позвоноч-но-тазового баланса как фактора, предрасполагающего к прогрессированию спондилолистеза. Проанализировав параметры сагиттального баланса у 100 пациентов с деге-неративным спондилолистезом, которым было выполне-но оперативное лечение, авторы отметили, что прогресси-рование дегенеративного спондилолистеза связано с большим тазобедренным углом (PI).…”

Section: вопросы нейрохирургии 5 2015unclassified

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A change in the sagittal balance in elderly and senile patients with degenerative stenosis of the lumbar spine

Василенко

et al. 2015

Vopr. neirokhir.

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Дегенеративно-дистрофические поражения позво-ночника занимают первое место среди всех ортопедиче-ских заболеваний взрослых, составляя свыше 40%.Увеличивающаяся средняя продолжительность жиз-ни приводит к увеличению числа пациентов пожилого и старческого возраста. По определению ВОЗ, к пожилому населению относятся граждане в возрасте от 60 до 74 лет, к старческому -от 75 до 89 лет. В России доля людей по-жилого и старческого возраста превышает 20%. Для этих пациентов характерна высокая заболеваемость, среди ко-торой лидируют сердечно-сосудистые, онкологические заболевания, а также болезни опорно-двигательного ап-парата. Распространенность боли в спине в этой группе, по данным различных исследований, варьирует от 6 до 51%. Большинство авторов отмечают преобладание мно-гоуровневых стенотических поражений позвоночного столба, которые в некоторых случаях могут потребовать проведения декомпрессивных или декомпрессивно-ста-билизирующих оперативных вмешательств.В настоящее время не существует единого подхода в вопросах выбора вида и объема оперативного лечения. Дегенеративно-дистрофические изменения позвоночника носят универсальный характер, что приводит к изменениям параметров сагиттального баланса и, следовательно, других элементов опорно-двигательного аппарата. В статье проведен анализ литературы отечественных и зарубежных авторов, на основании которого можно сделать вывод, что на сегодняш-ний день остаются неизученными изменения параметров сагиттального баланса у пациентов пожилого и старческого возраста в стадии рестабилизации. Ключевые слова: сагиттальный баланс, пациенты пожилого и старческого возраста, дегенеративный стеноз поясничного отдела позвоночника.A change in the sagittal balance in elderly and senile patients with degenerative stenosis of the lumbar spine Degenerative-dystrophic changes in the spine have general nature, which leads to changes in the sagittal balance parameters and, consequently, other elements of the musculoskeletal system. This article is devoted to analysis of the literature data, based on which we conclude that changes in the sagittal balance in elderly and senile patients at the restabilization stage still remain unexplored.Keywords: sagittal balance, elderly and senile patients, degenerative stenosis of the lumbar spine.Обсуждается вопрос о необходимости и методах фик-сации оперированного позвоночно-двигательного сег-мента.Цель публикации -познакомить нейрохирургов с современным подходом к хирургическому лечению деге-неративного стеноза позвоночного канала у пожилых.Изменения в позвоночнике представляют собой про-явления естественных возрастных изменений и характе-ризуются термином «дегенеративный каскад». Эти изме-нения носят универсальный характер, при этом многооб-разие клинических проявлений связано с вторичными неврологическими расстройствами, проявляющимися в виде радикулопатий, рефлекторных болевых синдромов, синдрома нейрогенной перемежающейся хромоты, а так-же с формированием нарушений постурального баланса и патологических двигательных стереотипов.Авторы теории «естествен...

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Section: вопросы нейрохирургии 5 2015unclassified

A change in the sagittal balance in elderly and senile patients with degenerative stenosis of the lumbar spine

Василенко

et al. 2015

Vopr. neirokhir.

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“…13,30,38,40 Through understanding this relationship in healthy subjects, parameters have been established for diagnosis and treatment in patients with spinal deformity. The pelvis in the sagittal plane is commonly analyzed using 3 angular measurements: pelvic tilt, pelvic incidence, and sacral slope.…”

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confidence: 99%

“…4,18 The higher the sacral slope, the greater the likelihood of spondylolisthesis. 13,18 It is hypothesized that the increased sacral slope creates greater lumbosacral lordosis, which in turn creates higher stress across the pars region. 27 The influence of sacral slope on lumbosacral shear and its importance in selecting implants has not been studied in a biomechanics laboratory.…”

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The role of sacral slope in lumbosacral fusion: a biomechanical study

Drazin¹,

Hussain

Harris

et al. 2015

SPI

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OBJECT Abnormal sacral slope (SS) has shown to increase progression of spondylolisthesis, yet there exists a paucity in biomechanical studies investigating its role in the correction of adult spinal deformity, its influence on lumbosacral shear, and its impact on the instrumentation selection process. This in vitro study investigates the effect of SS on 3 anterior lumbar interbody fusion constructs in a biomechanics laboratory. METHODS Nine healthy, fresh-frozen, intact human lumbosacral vertebral segments were tested by applying a 550-N axial load to specimens with an initial SS of 20° on an MTS Bionix test system. Testing was repeated as SS was increased to 50°, in 10° increments, through an angulated testing fixture. Specimens were instrumented using a standalone integrated spacer with self-contained screws (SA), an interbody spacer with posterior pedicle screws (PPS), and an interbody spacer with anterior tension band plate (ATB) in a randomized order. Stiffness was calculated from the linear portion of the load-deformation curve. Ultimate strength was also recorded on the final construct of all specimens (n = 3 per construct) with SS of 40°. RESULTS Axial stiffness (N/mm) of the L5–S1 motion segment was measured at various angles of SS: for SA 292.9 ± 142.8 (20°), 277.2 ± 113.7 (30°), 237.0 ± 108.7 (40°), 170.3 ± 74.1 (50°); for PPS 371.2 ± 237.5 (20°), 319.8 ± 167.2 (30°), 280.4 ± 151.7 (40°), 233.0 ± 117.6 (50°); and for ATB 323.9 ± 210.4 (20°), 307.8 ± 125.4 (30°), 249.4 ± 126.7 (40°), 217.7 ± 99.4 (50°). Axial compression across the disc space decreased with increasing SS, indicating that SS beyond 40° threshold shifted L5–S1 motion into pure shear, instead of compression-shear, defining a threshold. Trends in ultimate load and displacement differed from linear stiffness with SA > PPS > ATB. CONCLUSIONS At larger SSs, bilateral pedicle screw constructs with spacers were the most stable; however, none of the constructs were significantly stiffer than intact segments. For load to failure, the integrated spacer performed the best; this may be due to angulations of integrated plate screws. Increasing SS significantly reduced stiffness, which indicates that surgeons need to consider using more aggressive fixation techniques.

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“…4,5,15,27 These relationships have been documented in adult volunteers 4,5,7,15,29 and in patients with spondylolisthesis. 6,10,11,16,22,28 Spinopelvic alignment is now recognized as crucial in the assessment of an energy-efficient posture in both normal The treatment consisted of L4-sacrum reduction and fusion via a posterior approach, resulting in complete correction of lumbosacral kyphosis. Preoperative, 6-month postoperative, and final follow-up postoperative angular measurements were taken from full-spine lateral radiographs obtained with the patient in a standard standing position.…”

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confidence: 99%

Progressive restoration of spinal sagittal balance after surgical correction of lumbosacral spondylolisthesis before skeletal maturity

Thomas

Bachy

Courvoisier

et al. 2015

SPI

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OBJECT Spinopelvic alignment is crucial in assessing an energy-efficient posture in both normal and disease states, such as high-displacement developmental spondylolisthesis (HDDS). The overall effect in patients with HDDS who have undergone local surgical correction of lumbosacral imbalance for the global correction of spinal balance remains unclear. This paper reports the progressive spontaneous improvement of global sagittal balance following surgical correction of lumbosacral imbalance in patients with HDDS. METHODS The records of 15 patients with HDDS who underwent surgery between 2005 and 2010 were reviewed. The treatment consisted of L4–sacrum reduction and fusion via a posterior approach, resulting in complete correction of lumbosacral kyphosis. Preoperative, 6-month postoperative, and final follow-up postoperative angular measurements were taken from full-spine lateral radiographs obtained with the patient in a standard standing position. Radiographic measurements included pelvic incidence, sacral slope, lumbar lordosis, and thoracic kyphosis. The degree of lumbosacral kyphosis was evaluated by the lumbosacral angle. Because of the small number of patients, nonparametric tests were considered for data analysis. RESULTS Preoperative lumbosacral kyphosis and L-5 anterior slip were corrected by instrumentation. Transient neurological complications were noted in 5 patients. Statistical analysis showed a significant increase of thoracic kyphosis on 6-month postoperative and final follow-up radiographs (p < 0.001). A statistically significant decrease of lumbar lordosis was noted between preoperative and 6-month control radiographs (p < 0.001) and between preoperative and final follow-up radiographs (p < 0.001). CONCLUSIONS Based on the authors' observations, this technique resulted in an effective reduction of L-5 anterior slip and significant reduction of lumbosacral kyphosis (from 69.8° to 105.13°). Due to complete reduction of lumbosacral kyphosis and anterior trunk displacement associated with L-5 anterior slipping, lumbar lordosis progressively decreased and thoracic kyphosis progressively increased postoperatively. Adjusting the sagittal trunk balance produced not only pelvic anteversion, but also reciprocal adjustment of lumbar lordosis and thoracic kyphosis, creating a satisfactory level of compensated global sagittal balance.

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Comparative study of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis

Abstract: Greater PI may lead to the development and the progression of vertebral slip. Different compensatory mechanisms may contribute to the maintenance of spinopelvic sagittal alignment in DS and non-DS patients.

Cited by 107 publications

References 24 publications

A change in the sagittal balance in elderly and senile patients with degenerative stenosis of the lumbar spine

A change in the sagittal balance in elderly and senile patients with degenerative stenosis of the lumbar spine

The role of sacral slope in lumbosacral fusion: a biomechanical study

Progressive restoration of spinal sagittal balance after surgical correction of lumbosacral spondylolisthesis before skeletal maturity

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