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

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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 &lt; 0.001). A statistically significant decrease of lumbar lordosis was noted between preoperative and 6-month control radiographs (p &lt; 0.001) and between preoperative and final follow-up radiographs (p &lt; 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

Unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the treatment of degenerative lumbar spondylolisthesis: a retrospective analysis

“…The results of this study indicated that the sagittal parameters, such as the SLA, LL and SP improved in both groups postoperatively compared with preoperatively. Previous studies have indicated that effective reduction of slip can improve postoperative sagittal spinal balance [27] The maintenance of sagittal spinal balance is crucial for ensuring postural stability and minimizing energy consumption [28] . According to these findings, we can infer that ULIF surgery can improve local and regional sagittal balance.…”

A Surgical Treatment Algorithm for Restoring Pelvic Balance and Health-related Quality of Life in High-grade Lumbosacral Spondylolisthesis

“…Surgery for high-grade spondylolisthesis (HGS) has the potential to improve the health-related quality of life (HRQoL) 1 . There is also evidence supporting the central role of pelvic balance in the postural control and biomechanics for HGS 2–8 . Achieving adequate postoperative balance is associated with improved HRQoL 9,10 …”

“…1 There is also evidence supporting the central role of pelvic balance in the postural control and biomechanics for HGS. [2][3][4][5][6][7][8] Achieving adequate postoperative balance is associated with improved HRQoL. 9,10 In addition to the abnormal pelvic morphology characterizing HGS, 11,12 the local deformity at the lumbosacral junction can lead to an unbalanced pelvis.…”