Ideal sagittal profile restoration and ideal lumbar apex positioning play an important role in postoperative mechanical complications after a lumbar PSO

Pizones, Javier; Pérez-Grueso, Francisco Javier Sánchez; Moreno-Manzanaro, Lucía; Vila-Casademunt, Alba; Boissière, Louis; Yılgör, Çağlar; Fernández-Baíllo, Nicomedes; Sánchez-Márquez, José Miguel; Talavera, Gloria; Kleinstück, Frank; Acaroğlu, Emre; Alanay, Ahmet; Pellisé, Ferràn; Obeid, Ibrahim

doi:10.1007/s43390-019-00005-3

Cited by 27 publications

(20 citation statements)

References 38 publications

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“…Another important parameter for realignment procedures is the postoperative location of the LL apex. Based on Roussouly classification, Pizones et al recently reported a decrease in mechanical complications with an adapted postoperative lumbar apex position and lumbar shape restoration [ 16 , 17 ]. Of note, besides sagittal alignment goals, the use of multiple rods constructs has also been reported as a safe and effective method to reduce implant failures [ 18 , 19 ], but this strategy was not used in our experience.…”

Section: Discussionmentioning

confidence: 99%

Optimal Correction of Adult Spinal Deformities Requires Restoration of Distal Lumbar Lordosis

Pesenti

Prost

McCausland

et al. 2021

Advances in Orthopedics

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Purpose. The aim of this study is to analyze results according to postoperative pelvic incidence-lumbar lordosis (PI-LL) mismatch in the management of adult spine deformity (ASD) patients. Recently, it has been reported that in addition to lumbar lordosis amount, lordosis repartition between its proximal and distal parts was crucial. Methods. We enrolled 77 consecutive ASD patients who underwent posterior spinal fusion and deformity correction between 2015 and 2018. On preoperative and 1-year follow-up radiographs, we analyzed different parameters such as L1-S1 lumbar lordosis, L1-L4 proximal lordosis (PLL), L4-S1 distal lordosis (DLL), pelvic tilt (PT), sagittal vertical axis (SVA), and PI-LL mismatch. Comparisons were performed according to postoperative PI-LL mismatch (defined as “aligned” when PI-LL was <10°). The relationship between lordosis distribution and postoperative alignment status was investigated. Results. On the whole series, average lumbar lordosis, SVA, and PI-LL improved (28.2° vs.43.5°, 82 vs. 51 mm, and 26°vs. 14°, all p < 0.001 , respectively). On the other hand, PT remained unchanged (30° vs. 28°, p > 0.05 ). 35 patients were classified as “aligned” and 42 as “not aligned.” Patients from the “aligned” group had a significantly lower PI than patients from the “not aligned” group (52° vs. 61°, p = 0.009 ). Postoperative PLL was not different between groups (18° vs. 16° p > 0.05 ), whereas DLL was significantly higher in the “aligned” group (31° vs. 22°, p = 0.003 ). PI-LL was significantly correlated to DLL (rho = 0.407, p < 0.001 ) but not with PLL (rho = 0.110, p = 0.342 ). Conclusions. Our results revealed that in ASD patients, postoperative malalignment was associated with a lack of DLL restoration. “Not aligned” patients had also a significantly higher pelvic incidence. Specific attention must be paid to restore optimal distal lumbar lordosis in order to set the amount and the distribution of optimal postoperative lumbar lordosis.

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Section: Discussionmentioning

confidence: 99%

Optimal Correction of Adult Spinal Deformities Requires Restoration of Distal Lumbar Lordosis

Pesenti

Prost

McCausland

et al. 2021

Advances in Orthopedics

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“…13,38,39 It is now well established that the lordosis is unequally distributed with an increasing lordosis towards the lower segments. [14][15][16]40,41 The LDI was; therefore, proposed as part of the Global Alignment and Proportion score for predicting postoperative mechanical complications. 14,39…”

Section: Radiographic Parametersmentioning

confidence: 99%

Lordosis Distribution Index in Short-Segment Lumbar Spine Fusion – Can Ideal Lordosis Reduce Revision Surgery and Iatrogenic Deformity?

et al. 2021

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Objective: The demand for spinal fusion is increasing, with concurrent reports of iatrogenic adult spinal deformity (flatback deformity) possibly due to inappropriate lordosis distribution. This distribution is assessed using the lordosis distribution index (LDI) which describes the upper and lower arc lordosis ratio. Maldistributed LDI has been associated to adjacent segment disease following interbody fusion, although correlation to later-stage deformity is yet to be assessed. We therefore aimed to investigate if hypolordotic lordosis maldistribution was associated to radiographic deformity-surrogates or revision surgery following instrumented lumbar fusion.Methods: All patients undergoing fusion surgery ( ≤ 4 vertebra) for degenerative lumbar diseases were retrospectively included at a single center. Patients were categorized according to their postoperative LDI as: “normal” (LDI 50–80), “hypolordotic” (LDI < 50), or “hyperlordotic” (LDI > 80).Results: We included 149 patients who were followed for 21 ± 14 months. Most attained a normally distributed lordosis (62%). The hypolordotic group had increased postoperative pelvic tilt (PT) (p < 0.001), pelvic incidence minus lumbar lordosis (PI–LL) mismatch (p < 0.001) and decreased global lordosis (p = 0.007) compared to the normal group. Survival analyses revealed a significant difference in revision surgery (p = 0.03), and subsequent multivariable logistic regression showed increased odds of 1-year revision in the hypolordotic group (p = 0.04). There was also a negative, linear correlation between preoperative pelvic incidence (PI) and postoperative LDI (p < 0.001).Conclusion: In patients undergoing instrumented lumbar fusion surgery, hypolordotic lordosis maldistribution (LDI < 50) was associated to increased risk of revision surgery, increased postoperative PT and PI–LL mismatch. Lordosis distribution should be considered prior to spinal fusion, especially in high PI patients.

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“… 1 Ideal surgical restoration of these parameters is important to try to avoid mechanical complications. 36 , 37 …”

Section: Spino-pelvic Interactionsmentioning

confidence: 99%

Pelvic motion the key to understanding spine–hip interaction

Pizones

García-Rey

2020

EFORT Open Reviews

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Pelvic motion acting as a hinge between the spine and hips is essential to maintain proper balance during bipedalism. Pelvic rotation is recruited as a compensation mechanism when spinal malalignment occurs. This pelvic rotation can affect functional acetabular orientation, and consequently functional cup positioning if a total hip arthroplasty (THA) is needed. Pelvic retroversion, frequently associated with degenerative spinal changes, implies an increase of acetabular version. Patients with flexible lumbar spines (spine users) protect the hip joint. Patients with stiff, degenerated or fused lumbar spines (hip users) demand higher hip mobility, placing the THA at risk. Pelvises in retroversion place the THA at risk for anterior dislocation when standing. In contrast, pelvises in anteversion or with low pelvic incidence (PI) can place THA at risk for posterior dislocation when sitting. Try to set the cup in an anatomic position. However, bear in mind that low PI pelvises may need more acetabular ante-inclination, and high PI pelvises more acetabular retroversion. If surgery is needed, start first by addressing the hip, except in patients with compensation (high pelvic retroversion), who may need spine surgery first to place the pelvis, and consequently the acetabulum, in a proper position. Cite this article: EFORT Open Rev 2020;5:522-533. DOI: 10.1302/2058-5241.5.200032

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Ideal sagittal profile restoration and ideal lumbar apex positioning play an important role in postoperative mechanical complications after a lumbar PSO

Cited by 27 publications

References 38 publications

Optimal Correction of Adult Spinal Deformities Requires Restoration of Distal Lumbar Lordosis

Optimal Correction of Adult Spinal Deformities Requires Restoration of Distal Lumbar Lordosis

Lordosis Distribution Index in Short-Segment Lumbar Spine Fusion – Can Ideal Lordosis Reduce Revision Surgery and Iatrogenic Deformity?

Pelvic motion the key to understanding spine–hip interaction

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