Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2024; 91(1):17-23 | DOI: 10.55095/achot2024/001

Sagittal Profile of the Spine in Patients after Lumbar Stabilisation SurgeriesOriginal papers

J. PEŠEK¹, M. REPKO¹, L. RYBA¹, D. MATEJIČKA²

¹ Ortopedická klinika Lékařské fakulty Masarykovy univerzity a Fakultní nemocnice Brno, Česká republika

² Oddelenie traumatologie, Nemocnica Bory, Bratislava, Slovenská republika

Purpose of the study Spine stabilization surgery is nowadays one of the most common spinal surgical procedures. Spinopelvic alignment is considered to be an important factor impacting the patients' preoperative difficulties as well as the outcome of surgery. In our study, the outcomes of stabilization surgeries in patients with lumbar spine disorders were evaluated - especially in those with stenosis and spondylolisthesis, in whom the importance of sagittal parameters were assessed with respect to the patients' clinical outcomes and difficulties. Material and methods The study included 50 patients with lumbar spine disorders who had undergone a spine stabilization surgery for a degenerative disease - lumbar spinal stenosis, spondylolisthesis between 2015 and 2017. Spino-pelvic radiological parameters and clinical parameters were evaluated using the nonparametric Kruskal-Wallis, Mann-Whitney, and Wilcoxon tests. Results In 38 of 50 patients, who at the end of the follow-up period did not have the PI-LL (pelvic incidence-lumbar lordosis) mismatch, i.e. PI-LL was ≤10°, a statistically significant difference in pelvic tilt (p=0.049) and sagittal vertical axis (p<0.001) was reported, which was not the case in the remaining patients of the study population. Claudication and OSWESTRY (ODI) showed no statistically significant difference. We have also compared the differences in the number of fused vertebrae and type of stabilization. A significant change was seen in the claudication parameter at 12 and 24 months after surgery (p=0.007, p=0.005), with better outcomes achieved by 360° lumbar fusion compared to posterior lumbar fusion. The improvement of VAS and ODI scores in both the groups over time (from 6.1 to 3.6 or from 6.3 to 3.5 in VAS and from 62 to 32, or from 62 to 30 in ODI) was also statistically significant (p<0.001 in both groups), while when comparing the groups against each other it was statistically insignificant. Discussion The authors confirmed significant improvement in the studied clinical parameters in all groups of patients (VAS, ODI, claudication), which is consistent with the results of recently published papers. The authors also established the correlation between different radiological parameters in the studied groups. The results do not confirm the importance of the length or type of instrumentation for the clinical outcomes. This is consistent with the findings of other published manuscripts. The authors failed to confirm a significant change in clinical parameters in dependence on the matching relationship between the pelvic incidence and lumbar lordosis. Conclusions Proper spinopelvic balance in patients after spinal surgery is a very important indicator of postoperative development and condition, but our cohort showed no statistically significant difference in the clinical outcomes of patients whose postoperative sagittal parameters were unsatisfactory.

Keywords: sagittal profile, spine stabilization, pelvic tilt, pelvic incidence, sagittal vertical axis, SVA.

Published: February 1, 2024  Show citation