FUNCTIONAL DISABILITY, SAGITTAL ALIGNMENT AND PELVIC BALANCE IN LUMBAR SPONDYLOLISTHESIS

Luis Muñiz Luna,Edgar Negrete-Mundo,Enrique Salcedo Oviedo,Ana María Morales,Jorge Salvador De La Cruz Álvarez,Juvenal Ordaz,Hugo Vilchis Sámano,José Antonio Canales Nájera,Yadira Bahena Salgado,Marcos Marban Heredia

doi:10.1590/s1808-185120161501152836

Luis Muñiz Luna, Edgar Negrete-Mundo + Show 8 more

Open Access

https://doi.org/10.1590/s1808-185120161501152836

Copy DOI

Journal: Coluna/Columna	Publication Date: Mar 1, 2016
Citations: 2	License type: cc-by

Affiliation: Mexican Social Security Institute

Abstract

ABSTRACT Objectives: To demonstrate the recovery of lumbar sagittal pelvic alignment and sagittal pelvic balance after surgical reduction of lumbar spondylolisthesis and establish the benefits of the surgery for reduction and fixation of the lumbar spondylolisthesis with 360o circumferential arthrodesis for 2 surgical approaches by clinical and functional evaluation. Method: Eight patients with lumbar spondylolisthesis treated with surgical reduction and fixation of listhesis and segmental circumferential fusion with two surgical approaches were reviewed. They were evaluated before and after treatment with Oswestry, Visual Analogue for pain and Odom scales, performing radiographic measurement of lumbar sagittal alignment and pelvic sagittal balance with the technique of pelvic radius. Results: Oswestry scales and EVA reported improvement of symptoms after treatment in 8 cases; the Odom scale had six outstanding cases reported. The lumbar sagittal alignment presented a lumbosacral lordosis angle and a lumbopelvic lordosis angle reduced in 4 cases and increased in 4 other cases; pelvic sagittal balance increased the pelvic angle in 4 cases and decreased in 3 cases and the sacral translation of the hip axis to the promontory increased in 6 cases. Conclusion: The surgical procedure evaluated proved to be useful by modifying the lumbar sagittal alignment and the pelvic balance, besides reducing the symptoms, enabling the patient to have mobility and movement and the consequent satisfaction with the surgery.

Highlights

The human spine maintains proper balance in the sagittal and coronal planes in order to minimize the muscular effort required to maintain an erect posture when standing
The parameters of lumbosacral and lumbopelvic lordosis changed in 100% of the cases following the procedure, 50% increasing and the other 50% decreasing their values, but it was not possible the establish any relationship with the change in the pelvic balance parameter described by Legaye,[10] Tebet,[11] Lazennec,[13] and Videbaek.[14]
While we cannot say that there is recovery of the alignment and balance, we can say that the technique of reduction and fixation with circumferential arthrodesis alters the balance of the lumbar and pelvic segment

Summary

Introduction

The human spine maintains proper balance in the sagittal and coronal planes in order to minimize the muscular effort required to maintain an erect posture when standing. The degree of lumbar lordosis and the sagittal rotation of the pelvis around the hip axis is one of the compensatory mechanisms that maintains balance in the sagittal plane. The compensatory rotation of the pelvis in the sagittal plane is described using the pelvic radius technique, which was described by Jackson et al in 1994 at North Kansas City Hospital.[2,3,4,5,6,7,8]. One of the consequences of the variations in sagittal deformities (spondylolisthesis) is the reduced capacity to use this compensatory balance mechanism.[3,9,10,11]

Objectives

Findings

Discussion

Conclusion