Surgical treatment of patients with sagittal imbalance of degenerative etiology: a comparison of two methods

Abstract

Purpose. Compare the clinical and radiological results of treatment of patients with spinal deformities operated on using the PSO method and corrective fusion in the lumbar spine.
 Materials and methods. Retrospective monocenter cohort study. The data of 42 patients were analyzed. PSO (group I) was performed in 12 patients; 30 patients had a combination of surgical methods (group II) with mandatory ventral corrective spinal fusion at levels L4-L5, L5-S1. Clinical and radiological parameters were evaluated during hospitalization and at least 1 year later.
 Results. Postoperative hospitalization in group I 32.5 7.4 days, 27.1 7.4 in group II (p = 0.558758). The duration of the operation in group I was 402.5 55.6 minutes, in group II 526.0 116.2 minutes (p = 0.001124); blood loss 1862.5 454.3 ml versus 1096.0 543.3 ml (p = 0.000171). In both groups, significantly improved clinical and radiological parameters after surgery and after 1 year (p 0.05). In group II, as compared with group I after surgery and more than 1 year: lower back pain according to VAS (p = 0.015424 and p = 0.015424); below ODI after 1 year was (p = 0.000001). In group I, compared with group II after surgery and after 1 year, SVA is less (p = 0.029879 and p = 0.000014), lumbar lordosis is higher (p = 0.045002 and p = 0.024120), LDI is restored more optimally (p = 0.000001 and p = 0.000002), the GAP is lower (p = 0.005845 and p = 0.002639). The ideal Russoly type is restored more often in patients of group II (p = 0,00032). Complications in group I were noted in 12 (100%) patients, in group II in 13 (43.3%) patients (p = 0.001).
 Conclusions. In multistep surgical treatment compared with PSO, the anterior corrective interbody fusion L4-L5, L5-S1 reliably better and more harmoniously restores the sagittal balance parameters, has significantly lower volume of intraoperative blood loss, fewer perioperative complications and significantly improves the quality of life of patients.