Effect of lumbar pedicle subtraction osteotomy level on lordosis distribution and shape
| Autor: | Ibrahim Obeid, Javier Pizones, Louis Boissiere, Caglar Yilgor, Emre Acaroglu, Frank Kleinstück, Francisco Javier Sánchez Pérez-Grueso, Lucía Moreno-Manzanaro, Alba Vila-Casademunt, Ferran Pellisé, Ahmet Alanay |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Lordosis medicine.medical_treatment Radiography Osteotomy 03 medical and health sciences 0302 clinical medicine Lumbar medicine Humans Orthopedics and Sports Medicine Kyphosis Retrospective Studies Orthodontics 030222 orthopedics Lumbar Vertebrae business.industry Subtraction medicine.disease Sagittal plane Apex (geometry) Spinal Fusion medicine.anatomical_structure Inflection point Surgery business 030217 neurology & neurosurgery |
| Zdroj: | European Spine Journal. 29:1388-1396 |
| ISSN: | 1432-0932 0940-6719 |
| Popis: | Little is known about the qualitative results (postoperative upper/lower lumbar arches distribution and lumbar apex or inflection point positioning) of lumbar pedicle subtraction osteotomies (L-PSO) depending on the level of L-PSO.We conducted a retrospective analysis of prospectively collected data of adult deformity patients undergoing single-level L-PSO. We analyzed several variables in preoperative and postoperative sagittal radiographs: L-PSO level, Roussouly classification (R-type), inflection point (InfP), lumbar apex (LApex), spinopelvic parameters, lordosis distribution index (LDI = L4-S1/L1-S1), and number of levels in the lordosis (NVL). Comparisons between PSO levels were performed to determine lordosis distribution and sagittal shape using ANOVA test and Chi-squared statistics.A total of 126 patients were included in this study. L5-PSO mainly increased the lower lumbar arch, thereby increasing LDI. L4 increased upper/lower arches similarly. PSOs at and above L3 increased the upper lumbar arch, thereby decreasing LDI (P 0.001). L4-PSO added 1 vertebra into the lordosis (NVL = + 1.2 ± 2.2). PSOs above L3 added 2 vertebrae into the lordosis (NVL = + 2.3 ± 1.4). Overall P = 0.007. PSOs above L4 shifted the LApex cranially in 70% of the cases (mean 1.12 levels) and the InfP in 85% of the cases (mean 2.4 levels). L5-PSO shifted the LApex caudally in 70% of the cases (mean - 1.1 levels) and the InfP in 50% of the cases (mean - 1.6 levels). Overall P 0.006. The L-PSO level was not associated with a specific Roussouly-type P 0.05.The level of L-PSO influenced upper/lower lumbar arches distribution, and lumbar apex and inflection point positioning. The correct level should be chosen based on the individual assessment of each patient. |
| Databáze: | OpenAIRE |
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