Skip to main content
main-content

07.02.2018 | Original Article | Ausgabe 4/2018

European Spine Journal 4/2018

Georg Schmorl Prize of the German Spine Society (DWG) 2017: correction of spino-pelvic alignment with relordosing mono- and bisegmental TLIF spondylodesis

Zeitschrift:
European Spine Journal > Ausgabe 4/2018
Autoren:
Frederick Galla, Dirk Wähnert, Ulf Liljenqvist
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00586-018-5503-6) contains supplementary material, which is available to authorized users.

Abstract

Introduction

A balanced ratio of the main parameters of lumbar lordosis (LL) and pelvic incidence (PI) has high clinical relevance. A postoperative mismatch of LL and PI has been described in the literature to be associated with an inferior clinical outcome and higher postoperative revision rates. The aim of this retrospective, radiological study is to evaluate the magnitude of relordosing in mono-/bisegmental TLIF spondylodesis affecting the spino-pelvic alignment and the main contributing factors.

Materials and methods

164 patients (pat.) underwent monosegmental (n = 115, G1) and bisegmental (n = 49, G2) TLIF spondylodesis, respectively, for different indications in 2016 in our hospital. Pelvic incidence, lumbar lordosis (preop., postop., 3 months postop.), implanted cage sizes, and the use of additional Smith–Petersen osteotomies were analysed retrospectively. Patients were divided into three groups depending on match of LL/PI (PI-LL < 10° green, PI-LL = 10-20° yellow, PI-LL > 20° red). Furthermore, a differentiation was made between surgeons with more than or less than 10 years of spinal surgery experience, respectively.

Results

29.6% of pat. in G1 and 16.3% in G2 showed a highly pronounced preoperative spino-pelvic mismatch (red). A high grade of mismatch (yellow) between LL/PI was seen in 29.6% in G1 and in 38.8% in G2. The remaining patients already had a balanced ratio of LL/PI (green). Through relordosing TLIF the LL could be corrected significantly (p < 0.05). Therefore, the number of patients with a balanced sagittal alignment (green) increased from 40.9% preop. to 70.4% postoperative in G1 and from 44.9 to 85.7% in G2 (p < 0.05). The number of pat. with highly pronounced preoperative mismatch (red) could be lowered in G1 from 29.6 to 13.9% and in G2 from 16.3 to 2% postoperative (p < 0.05). In G1, the preoperative LL could be corrected from 46.3° to 53.8° (yellow) and 35.7° to 45.8° (red), while in G2, a correction was possible from 43.4° to 51.5° (yellow) and 36.6° to 50.1° (red) (p < 0.05). No significant difference of segmental/complete LL was found between radiologic measurement immediately postoperative and at the 3-month follow-up. In monosegmental fusion higher cages sizes lead to a better match of LL/PI (p < 0.05). The specific cage lordosis (5° vs. 10°) had no influence on the extent of relordosing. Experienced surgeons had significant higher postoperative matches of LL/PI (p < 0.05) and accomplished more osteotomies (p < 0.05).

Discussion

This retrospective study demonstrates that significant relordosing and, therefore, correction of the spino-pelvic alignment are possible with mono-/bisegmental TLIF spondylodesis. Positive influence of higher cage sizes and surgeon’s experience was shown. We conclude that the ratio of LL/PI should be taken into account preoperatively in lumbar fusion surgery when planning mono-/bisegmental TLIF spondylodesis to optimize spino-pelvic alignment.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

★ PREMIUM-INHALT
e.Med Interdisziplinär

Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf SpringerMedizin.de. Zusätzlich können Sie eine Zeitschrift Ihrer Wahl in gedruckter Form beziehen – ohne Aufpreis.

Jetzt e.Med bestellen und 100 € sparen!

Weitere Produktempfehlungen anzeigen
Zusatzmaterial
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 4/2018

European Spine Journal 4/2018 Zur Ausgabe
  1. Sie können e.Med Orthopädie & Unfallchirurgie 14 Tage kostenlos testen (keine Print-Zeitschrift enthalten). Der Test läuft automatisch und formlos aus. Es kann nur einmal getestet werden.

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Orthopädie und Unfallchirurgie und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise