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

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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.

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About the authors

Evgenii S. Baykov

Ya.L. Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: evgen-bajk@mail.ru
ORCID iD: 0000-0002-4430-700X
SPIN-code: 5367-5438
Scopus Author ID: 57189456380

MD, PhD, Head of the Department of Neurosurgery No. 2

Russian Federation, Frunze str., 17, Novosibirsk, 630091

Alexey V. Peleganchuk

Ya.L. Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Email: APeleganchuk@mail.com
ORCID iD: 0000-0002-4588-428X
Scopus Author ID: 57203729190

MD, PhD, Department of Neurosurgery No. 2

Russian Federation, Frunze str., 17, Novosibirsk, 630091

Abdugafur J. Sanginov

Ya.L. Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Email: Dr.sanginov@gmail.com
ORCID iD: 0000-0002-4744-4077
Scopus Author ID: 57202849091

MD, PhD, Department of Neurosurgery No. 2

Russian Federation, Frunze str., 17, Novosibirsk, 630091

Olga N. Leonova

Ya.L. Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Email: onleonova@gmail.com
ORCID iD: 0000-0002-9916-3947

MD, PhD, Research scientist

Russian Federation, Frunze str., 17, Novosibirsk, 630091

Aleksandr V. Krutko

Ya.L. Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Email: AKrutko@niito.ru
ORCID iD: 0000-0002-2570-3066
Scopus Author ID: 54795500200

MD, PhD, Head of the Department of Neurovertebrology

Russian Federation, Frunze str., 17, Novosibirsk, 630091

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Supplementary files

Supplementary Files
Action
1. Fig. 1. X-Ray scans of a 55-year-old patient with degenerative stenosis and sagittal imbalance, radiculopathy L4 and L5 on the left with severe pain in the lumbar spine: a and b — preoperative X-Ray scans in step mode at the anterior and lateral views. PI — 57°, PI-LL — 54°, PT — 35°, SVA — 109 mm, LDI — 33%, GAP — 11 points, III type Russouly. The patient underwent: PSO at L3 level, PLIF at the L4-L5 level, osteotomy Schwab II type at the L4-L5 level, posterior screw fixation at the L1-S1 levels; c and d (after 1 year) — X-Ray scans in step mode at the anterior and lateral views postoperatively. PI — 57 °, PI-LL — 5°, PT — 18°, SVA — 38 mm, LDI — 25%, GAP — 4 points

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2. Fig. 2. X-Ray scans of a 50-year-old patient with de novo lumbar scoliosis, sagittal imbalance, degenerative stenosis, with neurogenic intermittent claudication and severe pain in the lumbar spine: a and b — preoperative X-Ray scans in step mode at the anterior and lateral views. PI — 46°, PI-LL — 26°, PT — 18°, SVA — 78 mm, LDI — 96%, GAP — 7 points, III type Russouly. The patient underwent: ALIF at the L4-L5, L5-S1 levels and DLIF at the L2-L3, L4-L5 levels, osteotomy by Schwab I and II type at all lumbar levels, posterior screw fixation at the L2-S1 levels; c and d (after 1 year) — radiographs in step mode at the anterior and lateral views postoperatively. PI — 46°, PI-LL — 3°, PT — 13°, SVA — 30 mm, LDI — 79%, GAP — 2 points

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