F Lattig1, E Stettin2, S Weckbach3. 1. Orthopädische Wirbelsäulenchirurgie, Berit Paracelsus-Klinik AG, Voegelinsegg 5, 9042, Speicher, Schweiz. friederike.lattig@klinik.ch. 2. Klinik für Neurochirurgie, Bundeswehrkrankenhaus, Koblenz, Deutschland. 3. Orthopädische Universitätsklinik am RKU Ulm, Ulm, Deutschland.
Abstract
OBJECTIVE: Correction of a segmental or global lumbar hypolordosis to improve a sagittal imbalance. INDICATIONS: Lumbar segments fixed in kyphosis; degenerative or posttraumatic hypolordotic deformity of the lumbar spine with sagittal imbalance. CONTRAINDICATIONS: Bechterew disease; extended adhesions in the retroperitoneum. SURGICAL TECHNIQUE: Segmental correction of a kyphotic fixed segment using a unilateral transforaminal approach to release the annulus and anterior longitudinal ligament. With an additional posterior V‑shaped osteotomy, a segmental correction of more than 20° could be achieved to improve a global sagittal imbalance. POSTOPERATIVE MANAGEMENT: Back-friendly mobilisation starting the first day after surgery with support of a physiotherapist. No sports for 3-4 months. RESULTS: In all, 25 patients with 33 kyphotic fixed lumbar segments were treated using a complete anterior release of the annulus and anterior longitudinal ligament via a unilateral transforaminal approach. This enabled a lordosizing correction of the segment between 5° and 29° (mean 11.4°) without any neurological or vascular complications. A total of 10 patients treated with an additional posterior osteotomy were corrected 14-29° (mean 19°). There was a loss of reduction of the lordotic correction (mean 1°; range 0-3°) in the X‑ray control at a minimum follow-up of 6 months (range 6-33 months).
OBJECTIVE: Correction of a segmental or global lumbar hypolordosis to improve a sagittal imbalance. INDICATIONS: Lumbar segments fixed in kyphosis; degenerative or posttraumatic hypolordotic deformity of the lumbar spine with sagittal imbalance. CONTRAINDICATIONS: Bechterew disease; extended adhesions in the retroperitoneum. SURGICAL TECHNIQUE: Segmental correction of a kyphotic fixed segment using a unilateral transforaminal approach to release the annulus and anterior longitudinal ligament. With an additional posterior V‑shaped osteotomy, a segmental correction of more than 20° could be achieved to improve a global sagittal imbalance. POSTOPERATIVE MANAGEMENT: Back-friendly mobilisation starting the first day after surgery with support of a physiotherapist. No sports for 3-4 months. RESULTS: In all, 25 patients with 33 kyphotic fixed lumbar segments were treated using a complete anterior release of the annulus and anterior longitudinal ligament via a unilateral transforaminal approach. This enabled a lordosizing correction of the segment between 5° and 29° (mean 11.4°) without any neurological or vascular complications. A total of 10 patients treated with an additional posterior osteotomy were corrected 14-29° (mean 19°). There was a loss of reduction of the lordotic correction (mean 1°; range 0-3°) in the X‑ray control at a minimum follow-up of 6 months (range 6-33 months).
Authors: Iulian Popa; Manuel Oprea; Diana Andrei; Peter Mercedesz; Mihai Mardare; Dan V Poenaru Journal: Int Orthop Date: 2016-02-24 Impact factor: 3.075
Authors: Hamid Hassanzadeh; Amit Jain; Mostafa H El Dafrawy; Michael C Ain; Addisu Mesfin; Richard L Skolasky; Khaled M Kebaish Journal: Spine (Phila Pa 1976) Date: 2013-04-20 Impact factor: 3.468