Sagittal Balance Before and after Pregnancy. Nature Course and Influence of Performed Spine Surgery Method

Abstract

Introduction The amount of spine surgeries grow each year. Spine diseases usually associated with advanced age start to appear in much younger patients. The matter of sagittal balance plays a crucial role in modern spine surgery. Knowledge of pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and spino-sacral angle (SSA) is mandatory in any modern spine procedure. However, so well understood spine parameters are almost never associated with pregnancy. Materials and Methods In our study, we decided to measure all the important spine parameters in a group of young women before pregnancy (healthy and women after spine surgical procedures on L4–S1) and after delivery. One of the most important questions is how to operate a young women properly in the reproductive period (discectomy vs. posterior transpedicular stabilization and PLIF/TLIF fusion). The study includes 90 women (30 in each group). Overall, 30 healthy with no syndromes before and after surgery, 30 who underwent microdiscectomy on L4–S1 level, and 30 who underwent posterior transpedicular and TLIF/PLIF fusion on L4–S1 level. All women had a sagittal balance spine measurements before and after pregnancy (pelvic incidence, pelvic tilt, sacral slope, and spino-sacral angle). The parameters have been comprised and proper conclusions were drawn. Results In all operated women before the surgical procedure, sagittal balance was changed. After pregnancy only in fused group, proper sagittal balance was retained. In the other groups (discectomy and healthy), sagittal balance was impaired after delivery. Conclusions Sagittal balance changes during natural pregnancy course. Posterior transpedicular stabilization with PLIF/TLIF fusion performed before pregnancy characterized better long-term follow-up than pure discectomy. Also, reoperation proportion was significantly lower in the fused group. In women in reproductive period, surgical procedures based on fusion and sagittal balance correction seems to be a method of choice.