Correction of sagittal imbalance after previous surgical interventions for degenerative lumbar spine disease

Objective. To analyze clinical and radiological results of corrective fusion in the lumbar spine in the treatment of patients with sagittal imbalance after previous surgical interventions.

Material and Methods. A retrospective monocentric study, clinical case series. The data of 18 patients operated on using a combination of surgical methods with obligatory anterior corrective  fusion at the L4–L5 and/or L5–S1 levels to achieve optimal parameters of the sagittal balance  disturbed or developed after previous interventions were analyzed. Clinical and radiological parameters were assessed during hospital stay and at least 10 months later.

Results. The study presents data from 3 (16.7 %) men and 15 (83.3 %) women with an average age of 57.5 ± 9.1 years. Average length of hospital stay was 26.9 ± 10.1 days. In 7 (38.9 %) cases, the deformity occurred at the previously operated level and in 11 (61.1 %) – at the adjacent one. The duration of surgery was 481.4 ± 101.7 minutes, and blood loss was 1028.9 ± 594.9 ml. Back and leg pain VAS scores decreased in 10–19 months after surgery from 6.4 ± 0.9 and 4.8 ± 1.3 to 3.2 ± 1.2 and 0.9 ± 0.8, respectively (p < 0.001). The ODI score decreased from 59.6 ± 5.9 to 39.9 ± 7.7 (p < 0.001). The ideal Roussouly type was restored in 11 (61.1 %) cases, below ideal – in 3 (16.7 %), and overcorrection – in 4 (22.2 %). LL increased from 48.1 ± 13.6 ° to 56.9 ± 11.6 ° (p < 0.001), and LDI – from 40.1 ± 16.9 to 58.8 ± 10.3 (p <0.001); SVA decreased from 5.1 ± 1.9 to 3.4 ± 2.1 cm (p < 0.001), PT – from 23.9° ± 7.2° to 19.1° ± 3.8° (p < 0.001). According to GAP score, the number of patients with severe and moderate disproportion was reduced (p < 0.001). Perioperative complications were observed in 12 (66.7 %) patients.

Conclusion. Multi-stage surgical correction of the residual and aggravated sagittal imbalance with obligatory anterior corrective interbody fusion after instrumental correction of degenerative spinal deformity through the posterior approach significantly improves clinical and radiological parameters and allows restoring a harmonious sagittal profile in 61.1 % of cases.

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