Relationship between global sagittal balance and clinical outcome in patients treated with lumbar fusion
Keywords:
Sagittal Balance, ODI Score, Low Back Pain, Pelvic Tilt, Pelvic Incidence, Sacral Slope, Lumbar Lordosis, C7 Plumb Line Distance, Lumbar FusionAbstract
Introduction:
Normal anatomy of the spine curvature has the function to distribute axial loading, especially in standing position. Sagittal balance parameters consist of pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL) and C7 plumb line distance (C7PL). Changes in these parameters may cause pain and other disabilities. This research aims to show the correlation between the parameters of sagittal balance and clinical outcome measured using ODI score and to show whether the sagittal balance parameters are corrected post-operatively.
Methods:
Data was collected in dr. Cipto Mangunkusumo Hospital, Jakarta. The study design is analytic observational with cohort. There were 31 subjects consisted of male and female adult that underwent lumbar fusion from January 2016 to July 2017. In this study, we included 22 patients with degenerative diseases, 8 patients with infection, and 1 patient with malignancy. All patients got whole spine X-rays and filled the ODI score questionnaire before and after the surgery. The sagittal balance parameters were measured using Surgimap software.
Results:
The results showed that there was no significant relationship between PT, LL, C7PL and the improvement of patients statistically. However, there was significant correlation between PI and SS and the improvement of patients
statistically. The sagittal balance, unfortunately, was not significantly corrected
Conclusion:
From a previous study conducted in Indonesia, it is showed that PI and C7PL were significant clinically. However, the present study concluded that PI and SI were the ones influencing the clinical outcome. We found that the current surgical technique did not correct the sagittal balance parameters, which may be due to the difficulty in monitoring the correction intraoperatively.
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References
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