Single Level Spondylolisthesis Associated Sagittal Plane Imbalance Corrected by Pre-Psoas Interbody Fusion Using Anterior Column Release with 30° Expandable Hyperlordotic Cage
<i>Background:</i> Loss of lumbar lordosis caused by single level degenerative spondylolisthesis can trigger significant sagittal plane imbalance and failure to correct lumbopelvic parameters during lumbar fusion can lead to poor outcome or worsening deformity. Anterior column release (A...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-08-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/58/9/1172 |
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| author | Mansour Mathkour Stephen Z. Shapiro Tyler Scullen Cassidy Werner Mitchell D. Kilgore Velina S. Chavarro Daniel R. Denis |
| author_facet | Mansour Mathkour Stephen Z. Shapiro Tyler Scullen Cassidy Werner Mitchell D. Kilgore Velina S. Chavarro Daniel R. Denis |
| author_sort | Mansour Mathkour |
| collection | DOAJ |
| description | <i>Background:</i> Loss of lumbar lordosis caused by single level degenerative spondylolisthesis can trigger significant sagittal plane imbalance and failure to correct lumbopelvic parameters during lumbar fusion can lead to poor outcome or worsening deformity. Anterior column release (ACR) through a pre-psoas approach allows the placement of a hyperlordotic cage (HLC) to improve lumbar lordosis, but it is unclear if the amount of cage lordosis affects radiological outcomes in real-life patient conditions. <i>Methods:</i> Three patients were treated with ACR and 30° expandable HLC for positive sagittal imbalance secondary to single-level spondylolisthesis. Patients reported baseline and post-operative Oswestry Disability Index (ODI) and Numeric Pain Score (NRS). Radiographic parameters of sagittal balance included lumbar lordosis (LL), sagittal vertical axis (SVA) and pelvic incidence-lumbar lordosis mismatch (PI-LL). <i>Results:</i> Surgical indications were sagittal plane imbalance caused by L4–L5 degenerative spondylolisthesis (n = 2) and L3–L4 spondylolisthesis secondary to adjacent segmental degeneration (n = 1). Average post-operative length of stay was 3 days (range 2–4) and estimated blood loss was 266 mL (range 200–300). NRS and ODI improved in all patients. All experienced improvements in LL (<inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mover accent="true"><mi>x</mi><mo>¯</mo></mover></semantics></math></inline-formula>preop = 33°, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mover accent="true"><mi>x</mi><mo>¯</mo></mover></semantics></math></inline-formula>postop = 56°), SVA (<inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mover accent="true"><mi>x</mi><mo>¯</mo></mover></semantics></math></inline-formula>preop = 180 mm, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mover accent="true"><mi>x</mi><mo>¯</mo></mover></semantics></math></inline-formula>postop = 61 mm) and PI-LL (<inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mover accent="true"><mi>x</mi><mo>¯</mo></mover></semantics></math></inline-formula>preop = 26°, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mover accent="true"><mi>x</mi><mo>¯</mo></mover></semantics></math></inline-formula>postop = 5°). <i>Conclusion:</i> ACR with expandable HLC can restore sagittal plane balance associated with single-level spondylolisthesis. Failure to perform ACR with HLC placement during pre-psoas interbody fusion may result in under correction of lordosis and poorer outcome for these patients. |
| first_indexed | 2024-03-09T23:14:40Z |
| format | Article |
| id | doaj.art-664927c1a2d44975b538714ef2123ca7 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-09T23:14:40Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-664927c1a2d44975b538714ef2123ca72023-11-23T17:38:56ZengMDPI AGMedicina1010-660X1648-91442022-08-01589117210.3390/medicina58091172Single Level Spondylolisthesis Associated Sagittal Plane Imbalance Corrected by Pre-Psoas Interbody Fusion Using Anterior Column Release with 30° Expandable Hyperlordotic CageMansour Mathkour0Stephen Z. Shapiro1Tyler Scullen2Cassidy Werner3Mitchell D. Kilgore4Velina S. Chavarro5Daniel R. Denis6Department of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USADepartment of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USADepartment of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USADepartment of Neurosurgery, Northwell Health, Manhasset, NY 11030, USADepartment of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USAFaculty of Medicine, University of Queensland, Brisbane, QLD 4029, AustraliaDepartment of Neurological Surgery, Ochsner Health, New Orleans, LA 70121, USA<i>Background:</i> Loss of lumbar lordosis caused by single level degenerative spondylolisthesis can trigger significant sagittal plane imbalance and failure to correct lumbopelvic parameters during lumbar fusion can lead to poor outcome or worsening deformity. Anterior column release (ACR) through a pre-psoas approach allows the placement of a hyperlordotic cage (HLC) to improve lumbar lordosis, but it is unclear if the amount of cage lordosis affects radiological outcomes in real-life patient conditions. <i>Methods:</i> Three patients were treated with ACR and 30° expandable HLC for positive sagittal imbalance secondary to single-level spondylolisthesis. Patients reported baseline and post-operative Oswestry Disability Index (ODI) and Numeric Pain Score (NRS). Radiographic parameters of sagittal balance included lumbar lordosis (LL), sagittal vertical axis (SVA) and pelvic incidence-lumbar lordosis mismatch (PI-LL). <i>Results:</i> Surgical indications were sagittal plane imbalance caused by L4–L5 degenerative spondylolisthesis (n = 2) and L3–L4 spondylolisthesis secondary to adjacent segmental degeneration (n = 1). Average post-operative length of stay was 3 days (range 2–4) and estimated blood loss was 266 mL (range 200–300). NRS and ODI improved in all patients. All experienced improvements in LL (<inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mover accent="true"><mi>x</mi><mo>¯</mo></mover></semantics></math></inline-formula>preop = 33°, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mover accent="true"><mi>x</mi><mo>¯</mo></mover></semantics></math></inline-formula>postop = 56°), SVA (<inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mover accent="true"><mi>x</mi><mo>¯</mo></mover></semantics></math></inline-formula>preop = 180 mm, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mover accent="true"><mi>x</mi><mo>¯</mo></mover></semantics></math></inline-formula>postop = 61 mm) and PI-LL (<inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mover accent="true"><mi>x</mi><mo>¯</mo></mover></semantics></math></inline-formula>preop = 26°, <inline-formula><math xmlns="http://www.w3.org/1998/Math/MathML" display="inline"><semantics><mover accent="true"><mi>x</mi><mo>¯</mo></mover></semantics></math></inline-formula>postop = 5°). <i>Conclusion:</i> ACR with expandable HLC can restore sagittal plane balance associated with single-level spondylolisthesis. Failure to perform ACR with HLC placement during pre-psoas interbody fusion may result in under correction of lordosis and poorer outcome for these patients.https://www.mdpi.com/1648-9144/58/9/1172sagittal plane imbalancesingle-level spondylolisthesisminimally invasive anterior column releaseexpandable hyperlordotic cageanterior to psoas interbody fusion |
| spellingShingle | Mansour Mathkour Stephen Z. Shapiro Tyler Scullen Cassidy Werner Mitchell D. Kilgore Velina S. Chavarro Daniel R. Denis Single Level Spondylolisthesis Associated Sagittal Plane Imbalance Corrected by Pre-Psoas Interbody Fusion Using Anterior Column Release with 30° Expandable Hyperlordotic Cage Medicina sagittal plane imbalance single-level spondylolisthesis minimally invasive anterior column release expandable hyperlordotic cage anterior to psoas interbody fusion |
| title | Single Level Spondylolisthesis Associated Sagittal Plane Imbalance Corrected by Pre-Psoas Interbody Fusion Using Anterior Column Release with 30° Expandable Hyperlordotic Cage |
| title_full | Single Level Spondylolisthesis Associated Sagittal Plane Imbalance Corrected by Pre-Psoas Interbody Fusion Using Anterior Column Release with 30° Expandable Hyperlordotic Cage |
| title_fullStr | Single Level Spondylolisthesis Associated Sagittal Plane Imbalance Corrected by Pre-Psoas Interbody Fusion Using Anterior Column Release with 30° Expandable Hyperlordotic Cage |
| title_full_unstemmed | Single Level Spondylolisthesis Associated Sagittal Plane Imbalance Corrected by Pre-Psoas Interbody Fusion Using Anterior Column Release with 30° Expandable Hyperlordotic Cage |
| title_short | Single Level Spondylolisthesis Associated Sagittal Plane Imbalance Corrected by Pre-Psoas Interbody Fusion Using Anterior Column Release with 30° Expandable Hyperlordotic Cage |
| title_sort | single level spondylolisthesis associated sagittal plane imbalance corrected by pre psoas interbody fusion using anterior column release with 30° expandable hyperlordotic cage |
| topic | sagittal plane imbalance single-level spondylolisthesis minimally invasive anterior column release expandable hyperlordotic cage anterior to psoas interbody fusion |
| url | https://www.mdpi.com/1648-9144/58/9/1172 |
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