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2021, Number 3

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Ortho-tips 2021; 17 (3)

Screw to the sacrum (S1) as a treatment for the improvement of sagittal balance in patients with L4-L5 spondylolisthesis

Sánchez GO, García RLA, Patiño LJM, González CAC, Jiménez ?JM

Language: Spanish
References: 20
Page: 131-137
PDF size: 188.32 Kb.


ABSTRACT

Introduction: Spondylolisthesis is the sliding of one vertebra over another underlying one. The level that is most frequently affected (73%) is that corresponding to L4-L5. Treatments range from conservative to posterolateral fusion with fixation with transpedicular screws with intersomatic spacers. Spinopelvic balance is determined by the interaction or alignment of the pelvis and the lumbar spine being the pelvic spine imbalance an important factor in the development of this pathology. Objective: To assess the modification of the sagittal balance with the placement of a screw to the sacrum (S1) in the L4-L5 spondylolisthesis. Material and methods: Spine service patients were included, diagnosed with L4-L5 spondylolisthesis, with lumbar or lumbosacral vertebral instrumentation. A pre and postsurgical radiological study was carried out to assess the sagittal balance and the application of the Oswestry quality of life test, before and after surgery (0, 3 and 6 months). Results: 11 surgeries in patients diagnosed with L4-L5 spondylolisthesis. 27% were instrumented up to the sacrum, the rest were instrumented L4-L5, statistical analysis was performed reporting that the use of the transpedicular screw to S1 improves the sagittal balance of the lumbar lordosis, pelvic incidence, and pelvic tilt. Conclusion: The use of the pedicle screw at the level of S1 in the treatment of L4-L5 spondylolisthesis, improves the spinopelvic sagittal balance, since it acts as a fulcrum for the correction of lumbar lordosis and sacral inclination, by obtaining a good sagittal balance, obtain better clinical results.


REFERENCES

  1. Hegde D, Mehra S, Babu S, Ballal A. A study to assess the functional outcome of decompression and posterior lumbar interbody fusion of low grade spondylolisthesis of lumbar vertebra. J Clin Diagn Res. 2017; 11 (3): RC01-RC03.

  2. Song D, Song D, Zhang K, Chen Z, Wang F, Xuan T. Double-level isthmic spondylolisthesis treated with posterior lumbar interbody fusion: A review of 32 cases. Clin Neurol Neurosurg. 2017; 161: 35-40.

  3. de Kunder SL, van Kuijk SMJ, Rijkers K, Caelers IJMH, van Hemert WLW, de Bie RA, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J. 2017; 17 (11): 1712-1721.

  4. Guigui P, Ferrero E. Surgical treatment of degenerative spondylolisthesis. Orthop Traumatol Surg Res. 2017; 103 (1S): S11-S20.

  5. Grannum S, Torrie PA, Miller A, Harding IJ. Risk factors for the development of a mobile degenerative spondylolisthesis at L4-L5. Spine Deform. 2015; 3 (1): 98-104.

  6. Gille O, Challier V, Parent H, Cavagna R, Poignard A, Faline A, et al. Degenerative lumbar spondylolisthesis: cohort of 670 patients, and proposal of a new classification. Orthop Traumatol Surg Res. 2014; 100 (6 Suppl): S311-S315.

  7. Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat. 2016; 11: 39-52.

  8. Metz LN, Deviren V. Low-grade spondylolisthesis. Neurosurg Clin N Am. 2007; 18 (2): 237-248.

  9. Young S, DeWei S. Double-level isthmic spondylolisthesis treated with posterior lumbar interbody fusión: a review of 32cases. Clin Neurol Neurosurg. 2017; 162: 35-40.

  10. Phan KH, Daubs MD, Kupperman AI, Scott TP, Wang JC. Kinematic analysis of diseased and adjacent segments in degenerative lumbar spondylolisthesis. Spine J. 2015; 15 (2): 230-237.

  11. Hernandez NVR, Jacob JC, Machado CI, Batista JJL, Novo BMA, Cardoso MT. Spinopelvic balance evaluation of patients with degenerative spondylolisthesis L4L5 and L4L5 herniated disc who underwent surgery. Rev Bras Ortop. 2016; 51 (6): 662-666.

  12. Bakouny Z, Assi A, Massaad A, Saghbini E, Lafage V, Skalli W, et al. Roussouly's sagittal spino-pelvic morphotypes as determinants of gait in asymptomatic adult subjects. Gait Posture. 2017; 54: 27-33.

  13. Le Huec JC, Roussouly P. Sagittal spino-pelvic balance is a crucial analysisfor normal and degenerative spine. Eur Spine J. 2011; 20 (suppl 5): 556-557.

  14. Muñoz Gutiérrez J. Atlas de mediciones radiológicas. 2a ed. España: Editorial McGraw-Hill; 2011.

  15. Kapanji AI. Fisiología articular. Tomo 3: Tronco y raquis. 6a ed. Madrid: Editorial Panamericana; 2012.

  16. Jensen TS, Kjaer P, Korsholm L, Bendix T, Sorensen JS, Manniche C, et al. Predictors of new vertebral endplate signal (Modic) changes in the general population. Eur Spine J. 2010; 19 (1): 129-135.

  17. Ramírez GR, Ramírez MJJ, Sánchez LM, Juárez LB. El balance sagital en la columna lumbar degenerativa. Ortho-tips. 2015; 11 (3): 126-133.

  18. Vital M, García Suárez A, Sauri Barraza JC, Soderlund C, Gangnet N, Gille O. Equilibrio sagital y su aplicación en patologías de columna vertebral. Rev Ortop Traumatol. 2006; 50: 447-453.

  19. García Delgado I, García Fernández C, Lópiz Morales Y, León Serrano C, Alía Benítez J, Marco Martínez F, et al. Espondilolistesis degenerativas: fusión a un nivel vertebral. Rev Esp Cir Ortop Traumatol. 2008; 52: 381-385.

  20. Fandiño J, García-Abeledo M. Espondilolistesis degenerativa: tratamiento y resultados. Neurocirugía. 1994; 5: 136-140.




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