TY - JOUR
T1 - Surgical techniques in restoration lumbar lordosis
T2 - a biomechanical human cadaveric study
AU - Ochtman, A. E.A.
AU - Bisschop, A.
AU - Bleys, R. L.A.W.
AU - Öner, F. C.
AU - van Gaalen, S. M.
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2023/1
Y1 - 2023/1
N2 - Purpose: Degenerative changes of the lumbar spine lead in general to decrease of lumbar lordosis (LL). This change affects the overall balance of the spine, and when surgery is deemed, necessary restoration of the LL is considered. How this restoration can be achieved is a matter of controversy. The main purpose of this cadaveric study was to investigate the different steps of common posterior surgical techniques to understand the contribution of each successive step in restoring LL. Methods: Ten fresh-frozen human lumbar spine specimens were used to perform a sequential correction and instrumentation with a pedicle screw construct. Results: The mean LL angle measured at L3–L4 in intact condition was 12.9°; after screw insertion and compression, this increased to 13.8° (+ 7%, p = 0.04), after bilateral facetectomy to 16.3° (+ 20%, p = 0.005), after discectomy and insertion of interbody cage to 18.0º (+ 9%, p = 0.012), after resection of the lamina and the processes spinosus to 19.8° (+ 10%, p = 0.017), and after resection of the anterior longitudinal ligament to 25.4° (+ 22%, p = 0.005). Conclusions: Each step contributed statistically significant to restoration of segmental lordosis with bilateral facetectomy contributing the most in terms of percentage. Level of Evidence: IV.
AB - Purpose: Degenerative changes of the lumbar spine lead in general to decrease of lumbar lordosis (LL). This change affects the overall balance of the spine, and when surgery is deemed, necessary restoration of the LL is considered. How this restoration can be achieved is a matter of controversy. The main purpose of this cadaveric study was to investigate the different steps of common posterior surgical techniques to understand the contribution of each successive step in restoring LL. Methods: Ten fresh-frozen human lumbar spine specimens were used to perform a sequential correction and instrumentation with a pedicle screw construct. Results: The mean LL angle measured at L3–L4 in intact condition was 12.9°; after screw insertion and compression, this increased to 13.8° (+ 7%, p = 0.04), after bilateral facetectomy to 16.3° (+ 20%, p = 0.005), after discectomy and insertion of interbody cage to 18.0º (+ 9%, p = 0.012), after resection of the lamina and the processes spinosus to 19.8° (+ 10%, p = 0.017), and after resection of the anterior longitudinal ligament to 25.4° (+ 22%, p = 0.005). Conclusions: Each step contributed statistically significant to restoration of segmental lordosis with bilateral facetectomy contributing the most in terms of percentage. Level of Evidence: IV.
KW - Biomechanical
KW - Cadaveric
KW - Lordosis restoration
KW - Sagittal spinal alignment
UR - http://www.scopus.com/inward/record.url?scp=85135791181&partnerID=8YFLogxK
U2 - 10.1007/s43390-022-00549-x
DO - 10.1007/s43390-022-00549-x
M3 - Article
C2 - 35951242
AN - SCOPUS:85135791181
SN - 2212-134X
VL - 11
SP - 35
EP - 40
JO - Spine Deformity
JF - Spine Deformity
IS - 1
ER -