Editorial. Nuances of restoration of lumbar lordosis using an MIS anterior column release versus posterior 3-column osteotomy

Background: Anterior column realignment (ACR) is a minimally invasive technique used to restore lumbar lordosis and improve sagittal balance. The most feared complication from ACR includes injury to the great vessels. Segmental artery injuries are also a possible complication though sparsely reported. We report such a case. Case Description: During anterior longitudinal ligament release at L3-4, the L3 segmental artery was injured. Intraoperative angiogram and coiling was performed. Our patient remained hemodynamically stable though during the postoperative period his hemoglobin fell five points. Discussion: This patient was at risk for this complication due to the tortuosity of his vessels and his osteophytes. This injury can be treated concurrently with endovascular embolization if equipment and personnel are readily available. Ultimately, segmental artery injury does not appear to be as morbid as great vessel injury if addressed emergently.

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MIS lateral ACR for spinal deformity correction: technique and complication avoidance

Neurosurgical Focus: Video ◽

10.3171/2020.1.focusvid.19715 ◽

2020 ◽

Vol 2 (1) ◽

pp. V1

Author(s):

Ifije Ohiorhenuan ◽

Vedat Deviren ◽

Juan S. Uribe

Keyword(s):

Minimally Invasive ◽

Spinal Deformity ◽

Sagittal Balance ◽

Lumbar Lordosis ◽

Deformity Correction ◽

Lateral Approach ◽

Anterior Column ◽

Link Type ◽

Minimally Invasive Surgical ◽

Correction Technique

Deformity correction using minimally invasive surgical (MIS) techniques can be challenging. Here the authors present a case in which an anterior column resection was performed using an MIS lateral approach to restore lumbar lordosis and improve sagittal balance. The authors demonstrate the technique and discuss potential complications and how they may be avoided.The video can be found here: https://youtu.be/XjOdDeKrKEE.

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291. Influence of lumbar lordosis on posterior rod strain in long-segment pedicle screw and rod instrumentation with anterior column realignment: cadaveric study

The Spine Journal ◽

10.1016/j.spinee.2019.05.307 ◽

2019 ◽

Vol 19 (9) ◽

pp. S142

Author(s):

Bernardo De Andrada Pereira ◽

Jakub Godzik ◽

Jennifer Lehrman ◽

Anna G. Newcomb ◽

Randall J. Hlubek ◽

...

Keyword(s):

Pedicle Screw ◽

Lumbar Lordosis ◽

Cadaveric Study ◽

Anterior Column

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The impact of increasing interbody fusion levels at the fractional curve on lordosis, curve correction, and complications in adult patients with scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2020.6.spine20256 ◽

2020 ◽

pp. 1-10

Author(s):

Dominic Amara ◽

Praveen V. Mummaneni ◽

Shane Burch ◽

Vedat Deviren ◽

Christopher P. Ames ◽

...

Keyword(s):

Postoperative Complications ◽

Revision Surgery ◽

Lumbar Lordosis ◽

Interbody Fusion ◽

Pelvic Incidence ◽

Secondary Analysis ◽

Lumbar Interbody Fusion ◽

Curve Correction ◽

Surgery Rates

OBJECTIVERadiculopathy from the fractional curve, usually from L3 to S1, can create severe disability. However, treatment methods of the curve vary. The authors evaluated the effect of adding more levels of interbody fusion during treatment of the fractional curve.METHODSA single-institution retrospective review of adult patients treated for scoliosis between 2006 and 2016 was performed. Inclusion criteria were as follows: fractional curves from L3 to S1 > 10°, ipsilateral radicular symptoms concordant on the fractional curve concavity side, patients who underwent at least 1 interbody fusion at the level of the fractional curve, and a minimum 1-year follow-up. Primary outcomes included changes in fractional curve correction, lumbar lordosis change, pelvic incidence − lumbar lordosis mismatch change, scoliosis major curve correction, and rates of revision surgery and postoperative complications. Secondary analysis compared the same outcomes among patients undergoing posterior, anterior, and lateral approaches for their interbody fusion.RESULTSA total of 78 patients were included. There were no significant differences in age, sex, BMI, prior surgery, fractional curve degree, pelvic tilt, pelvic incidence, pelvic incidence − lumbar lordosis mismatch, sagittal vertical axis, coronal balance, scoliotic curve magnitude, proportion of patients undergoing an osteotomy, or average number of levels fused among the groups. The mean follow-up was 35.8 months (range 12–150 months). Patients undergoing more levels of interbody fusion had more fractional curve correction (7.4° vs 12.3° vs 12.1° for 1, 2, and 3 levels; p = 0.009); greater increase in lumbar lordosis (−1.8° vs 6.2° vs 13.7°, p = 0.003); and more scoliosis major curve correction (13.0° vs 13.7° vs 24.4°, p = 0.01). There were no statistically significant differences among the groups with regard to postoperative complications (overall rate 47.4%, p = 0.85) or need for revision surgery (overall rate 30.7%, p = 0.25). In the secondary analysis, patients undergoing anterior lumbar interbody fusion (ALIF) had a greater increase in lumbar lordosis (9.1° vs −0.87° for ALIF vs transforaminal lumbar interbody fusion [TLIF], p = 0.028), but also higher revision surgery rates unrelated to adjacent-segment pathology (25% vs 4.3%, p = 0.046). Higher ALIF revision surgery rates were driven by rod fracture in the majority (55%) of cases.CONCLUSIONSMore levels of interbody fusion resulted in increased lordosis, scoliosis curve correction, and fractional curve correction. However, additional levels of interbody fusion up to 3 levels did not result in more postoperative complications or morbidity. ALIF resulted in a greater lumbar lordosis increase than TLIF, but ALIF had higher revision surgery rates.

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Prevalence of Lumbar Lordosis in Middle-Aged Females

Indian Journal of Public Health Research & Development ◽

10.37506/v11/i1/2020/ijphrd/193809 ◽

2020 ◽

Vol 11 (1) ◽

pp. 178

Author(s):

Manpreet Bajaj ◽

S. Anandh

Keyword(s):

Lumbar Lordosis ◽

Middle Aged

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Outcomes of Oblique Lateral Interbody Fusion for Adult Spinal Deformity: A Systematic Review and Meta-Analysis

Global Spine Journal ◽

10.1177/2192568220979145 ◽

2021 ◽

pp. 219256822097914

Author(s):

Lei Zhu ◽

Jun-Wu Wang ◽

Liang Zhang ◽

Xin-Min Feng

Keyword(s):

Systematic Review ◽

Lumbar Lordosis ◽

Interbody Fusion ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Meta Analysis ◽

Fusion Rate ◽

The Mean ◽

Oblique Lateral Interbody Fusion ◽

Lateral Interbody

Study Design: A systematic review and meta-analysis. Objectives: To evaluate clinical and radiographic outcomes, and perioperative complications of oblique lateral interbody fusion (OLIF) for adult spinal deformity (ASD). Methods: We performed a systematic review and meta-analysis of related studies reporting outcomes of OLIF for ASD. The clinical outcomes were assessed by visual analogue scale (VAS) and Oswestry Disability Index (ODI). The radiographic parameters were evaluated by sagittal vertical axis (SVA), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence-lumbar lordosis (PI-LL), Cobb angle and fusion rate. A random effects model and 95% confidence intervals (CI) were performed to investigate the results. Results: A total of 16 studies involving 519 patients were included in the present study. The mean difference of VAS-back score, VAS-leg score and ODI score before and after surgery was 5.1, 5.0 and 32.3 respectively. The mean correction of LL was 20.6°, with an average of 6.9° per level and the mean correction of Cobb was 16.4°, with an average of 4.7° per level. The mean correction of SVA, PT, SS, TK and PI-LL was 59.3 mm, 11.7°, 6.9°, 9.4° and 20.6° respectively. The mean fusion rate was 94.1%. The incidence of intraoperative and postoperative complications was 4.9% and 29.6% respectively. Conclusions: OLIF is an effective and safe surgery method in the treatment of mild or moderate ASD and it has advantages in less intraoperative blood loss and lower perioperative complications.

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Significance of Lower Body Postures in Chair Design

Human Factors The Journal of the Human Factors and Ergonomics Society ◽

10.1177/00187208211027020 ◽

2021 ◽

pp. 001872082110270

Author(s):

Seulgi Kim ◽

Ilseok Lee ◽

Sang Hyeon Kang ◽

Sangeun Jin

Keyword(s):

Lower Extremity ◽

Lumbar Lordosis ◽

System Level ◽

Lumbar Region ◽

Muscle Recruitment ◽

Knee Angle ◽

Activity Measures ◽

Head Flexion ◽

Kinematic Measures ◽

The Cost

Objective This study examined a system-level perspective to investigate the changes in the whole trunk and head postures while sitting with various lower extremity postures. Background Sitting biomechanics has focused mainly on the lumbar region only, whereas the anatomy literature has suggested various links from the head and lower extremity. Method Seventeen male participants were seated in six lower extremity postures, and the trunk kinematics and muscle activity measures were captured for 5 s. Results Changes in the trunk-thigh angle and the knee angle affected the trunk and head postures and muscle recruitment patterns significantly, indicating significant interactions between the lower extremity and trunk while sitting. Specifically, the larger trunk-thigh angle (T135°) showed more neutral lumbar lordosis (4.0° on average), smaller pelvic flexion (1.8°), smaller head flexion (3.3°), and a less rounded shoulder (1.7°) than the smaller one (T90°). The smaller knee angle (K45°) revealed a more neutral lumbar lordosis (6.9°), smaller pelvic flexion (9.2°), smaller head flexion (2.6°), and less rounded shoulder (2.4°) than the larger condition (K180°). The more neutral posture suggested by the kinematic measures confirmed significantly less muscular recruitment in the trunk extensors, except for a significant antagonistic co-contraction. Conclusion The lower and upper back postures were more neutral, and back muscle recruitment was lower with a larger trunk-thigh angle and a smaller knee angle, but at the cost of antagonistic co-contraction. Application The costs and benefits of each lower extremity posture can be used to design an ergonomic chair and develop an improved sitting strategy.

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