Association of Sagittal Spinopelvic Realignment with Correction in Lower Lumbar Lordosis after Surgical Treatment in Degenerative Lumbar Scoliosis

Incidence and risk factors of new-onset sacroiliac joint pain after spinal surgery: a systematic review and meta-analysis

Purpose

A systematic review and meta-analysis for incidence and risk factors of new-onset sacroiliac joint pain (SIJP) after spinal surgery aimed to provide evidence-based medical references for its early prevention, timely intervention, and appropriate treatment.

Methodology

The protocol of the systematic review and meta-analysis was registered in the International Prospective Register of Systematic Review (PROSPERO) with the PROSPERO ID (CRD42023463177). Relevant studies were searched to January 2024 from the databases of PubMed, Embase, Cochrane Library, and Web of Science, and the types of studies were cohort studies, case-control studies, and cross-sectional studies. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and the Cross-Sectional/Prevalence Study Quality recommended by the Agency for Healthcare Research and Quality (AHRQ). Two authors conducted studies search, data extraction, and quality assessment independently. Meta-analyses were done using Stata 14.0 software.

Results

Twelve observational studies with 3,570 spinal surgery patients were included. Ten were case-control studies, one was a cross-sectional study, and another was a cohort study, all of which were of moderate quality and above. The results of the meta-analysis showed that the incidence of new-onset SIJP after spinal surgery was 9.40%; females, no. of surgical segments, fusion to the sacrum, and postoperative pelvic tilt (PT) were significantly associated with the new-onset SIJP after spinal surgery. Meta-analyses for preoperative and postoperative controls of spondylopelvic parameters showed that postoperative lumbar lordosis (LL) in the SIJP group and postoperative LL and sacral slope (SS) of patients in the NoSIJP group had significant differences from preoperative.

Conclusion

Available evidence suggests that an increased risk of new-onset SIJP after spinal surgery is associated with sex, multi-segmental surgery, fusion to the sacrum, and greater postoperative PT.

Modified S1 Pedicle Subtraction Osteotomy

STUDY DESIGN

Surgical technique video.

OBJECTIVE

To report a surgical technique to revise patients with previous fusions at L4-S1 leading to an iatrogenic flat back and sagittal imbalance using L5-S1 transforaminal interbody fusion combined with a small S1 corner osteotomy.

BACKGROUND

This is a case of a woman (51 y old) with a history of multiple lumbar surgeries, severe back pain, sagittal imbalance, and loss of lordosis.

METHODS

We describe a feasible revision technique in a complex patient with the goal of attaining optimal distribution of lumbar lordosis and sagittal balance through a modified S1 pedicle subtraction osteotomy, and the use of an interbody cage to enhance the fusion rate and facilitate closure of the 3-column osteotomy.

RESULTS

The preoperative patient lordosis angle of 31 degrees at L1-L4 and 16 degrees at L4-S1 became 12 degrees at L1-L4 and 44 degrees at L4-S1 postoperatively.

CONCLUSION

The combination of L5-S1 transforaminal interbody fusion and S1 corner osteotomy is a feasible technique for the restoration of lumbar lordosis in patients with previous fusion and consequent loss of lordosis.

Treatment of degenerative lumbar scoliosis using transforaminal lumbar interbody fusion based on the concept of intervertebral correction

PURPOSE

The study aimed to examine the outcomes of posterior approach transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar scoliosis (DLS) based on the concept of intervertebral correction.

METHODS

A retrospective analysis was performed on 76 surgical patients (36 males and 40 females) who underwent posterior TLIF and internal fixation based on the concept of intervertebral correction in Shenzhen Traditional Chinese Medicine Hospital from February 2014 to March 2021.The operation duration, intraoperative blood loss, incision length, and complications were recorded. Clinical efficacy was evaluated preoperatively and postoperative time points through the visual analog scale (VAS) and the Oswestry disability index (ODI). The changes in the coronal scoliosis curve (Cobb angle), coronal balance distance (CBD), the sagittal vertical axis (SVA), lumbar lordosis (LL), and pelvic tilt angle (PT) were assessed perioperatively at the last follow-up.

RESULTS

All patients successfully underwent the operation. The average operation duration was 243.81 ± 35.35 (220 - 350) min; the average intraoperative blood loss was 836.27 ± 50.28 (700 - 2500) mL; the average incision length was 8.30 ± 2.33 (8 - 15) cm. The total complication rate was 18.42% (14/76). The VAS score of low back pain, lower extremity pain, and ODI score of patients at the last follow-up was significantly improved compared with those before the operation (P < 0.05). At the last follow-up, the Cobb Angle, CBD, SVA, and PT of patients were significantly lower than those before the operation (P < 0.05), and LL was higher than those before the operation (P < 0.05).

CONCLUSION

TLIF based on the concept of intervertebral correction for the treatment of DLS may provide favourable clinical outcomes.

Association of spinopelvic index with proximal junctional failure developing in adult spinal deformity after surgical treatment: an observational study

BACKGROUND

Those pelvic parameters of sacral slope (SS) and pelvic tilt (PT) correlated significantly to lumbar spine and hip joints respectively. We proposed the match between SS and PT, namely spinopelvic index (SPI), in order to investigate whether the SPI correlated to proximal junctional failure (PJF) in adult spinal deformity (ASD) after correction surgery.

METHODS

Ninety-nine ASD patients who had undergone long-fusion (≥ 5 vertebras) surgeries were reviewed retrospectively in two medical institutions from January 2018 to December 2019. Those SPI were calculated with the equation: SPI = SS/PT, and analyzed using the receiver operating characteristic curve (ROC) analysis. All participants were subdivided into the observational and control group. Comparisons of demographics, surgical and radiographic data between the two groups were performed. A Kaplan-Meier curve and log-rank test was used to analyze the differences in PJF-free survival time, and the 95% confidence intervals (CI) were recorded respectively.

RESULTS

Nineteen patients suffering from PJF had much smaller postoperative SPI (P = 0.015), but much larger TK postoperatively (P < 0.001). ROC analysis determined the best cutoff value of 0.82 for SPI (sensitivity = 88.5%, specificity = 57.9%; AUC = 0.719, 95%CI: 0.612-0.864; P = 0.003). There were 19 and 80 cases in the observational (SPI ≤ 0.82) and control group (SPI > 0.82) respectively. The incidence of PJF in the observational group was much higher (11/19 VS 8/80, P < 0.001); further logistic regression analysis showed that SPI ≤ 0.82 was associated with increased odds of PJF (odds ratio: 12.375; 95%CI: 3.851-39.771). PJF-free survival time in the observational group decreased significantly (P < 0.001, log-rank test), moreover, multivariate analysis demonstrated that a value of SPI ≤ 0.82 (HR 6.626, 95%CI: 1.981-12.165) was significantly associated with PJF.

CONCLUSIONS

For ASD patients underwent long-fusion surgeries, the SPI should be over 0.82. The incidence of PJF may increase by 12-fold in such individuals with the immediate SPI ≤ 0.82 postoperatively.