Surgery for degenerative lumbar spondylolisthesis may entail both decompression and fusion. The knee-chest position facilitates the decompression, but fixation in this position risks fusion in kyphosis. This can be avoided by intra-operative re-positioning to the prone position. The aim of this study was to quantify the restoration of lordosis achieved by intra-operative repositioning and to assess the clinical and radiological outcome. A total of forty consecutive patients with degenerative lumbar spondylolisthesis and stenosis were treated by posterior decompression and interbody fusion with pedicle screw fixation. The screw insertion, decompression and interbody grafting were performed with the patient in the knee-chest position. The patient was then re-positioned to the fully prone position for fusion. Sagittal plane angles were measured pre-, intra- and post-operatively. Clinical assessment was performed using SF-36 scores and visual analogue scores for back and leg pain. The sagittal plane angle increased from median 16.0 degrees pre-operatively to 23.1 degrees post-operatively (p<0.01) and this was maintained at the last follow-up (mean 21 months). The SF-36 scores improved for 7 out of 8 domains and the physical score improved from 29% to 40% (p<0.05). The mean pain scores improved significantly from 7.5 to 3.8 for back pain and from 7.6 to 3.7 for leg pain (p<0.001). Lumbar spondylolisthesis was found to be associated with a reduction of normal lumbar lordosis and the knee-chest position exacerbates this loss of lordosis. Intra-operative repositioning restored lordosis to greater than the pre-operative angle and was associated with a good clinical outcome.
The spinopelvic alignment is often assessed via the Pelvic Incidence-Lumbar
Introduction. Hip osteoarthritis (OA) results in reduced hip range of motion and contracture, affecting sitting and standing posture. Spinal pathology such as fusion or deformity may alter the ability to compensate for reduced joint mobility in sitting and standing postures. The effects of postural spinal alignment change between sitting and standing is not well understood. Methods. A retrospective radiographic review was performed at a single academic institution of patients with sitting and standing full-body radiographs between 2012 and 2017. Patients were excluded if they had transitional lumbosacral anatomy, prior spinal fusion or hip prosthesis. Hip OA severity was graded by the Kellgren-Lawrence grades and divided into two groups: low-grade OA (LOA; grade 0–2) and severe OA (SOA; grade 3–4). Spinopelvic parameters (Pelvic Incidence (PI), Pelvic Tilt (PT), Lumbar
Purpose. To evaluate Radiological changes in the lumbosacral spine after insertion of Wallis Ligament for Foraminal Stenosis. Methods and Results. Thirty two Levels in Twenty Six patients were followed up with standardised radiographs after insertion of Wallis Ligaments for Foraminal Stenosis. Wallis ligaments as a top-off or those with prolapsed discs were not included. The Radiological parameters compared were Anterior and Posterior Disc height, Foraminal height and width, The inter-vertebral angle (IVA), Lumbar lordosis and Scoliosis if any. The presence of slips and their progression post-op was noted, as was bony lysis if any. There were ten males with thirteen levels and sixteen females with nineteen levels in the study. Eighteen levels (56.25%) were L4/L5, ten (31.25%) were L5/S1 and 4 (12.5%)were L3/L4. The average age in the series was 59.6 years (Range 37 – 89 yrs). Average follow up was 9.5 months (Range 2 to 36). The Average increase in Anterior disc height was 1.89 mm (+/−1.39), the posterior disc height increased by an average 1.09 mm (+/−1.14). Foraminal height increased by an average 3.85 mm (+/− 2.72), while foraminal width increased by 2.14 mm (+/− 1.38). The IVA increased in 16 and reduced in 15 patients, with no change in 1. Lumbar
