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Spinopelvic Alignment Preservation & Restoration: Considerations Should Be Made Before Lumbar Spinal Fusions

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Jackie Drees writes in Becker’s Spine Review that the preservation and restoration of a patient’s spinopelvic alignment should be incorporated into the decision-making of degenerative lumbar spinal fusions, according to a study published in Spine. See the study: https://www.ncbi.nlm.nih.gov/pubmed/29189645

Here are five things to know:

  1. The multicenter, institutional-review-board approved study was done at 18 U.S. institutions with 24 treating investigators.
  2. The study comprised 578 cases. Study patients underwent a one- or two-level lumbar fusion for a degenerative indication and had preoperative and postoperative standing lateral radiographs available for review.
  3. Using the patients’ measurements for lumbar lordosis, pelvic incidence and pelvic tilt, study participants were categorized into two pools preoperative and postoperative:

    • Aligned: PI-LL was less than 10 degrees or
    • Malaligned: PI-LL was greater than or equal to 10 degrees

  4. Patients were also grouped into categories based on pre-to-postoperative alignment progression:
  • Preserved — aligned to aligned
    • Restored — malaligned to aligned
    • Not corrected — malaligned to malaligned
    • Worsened — aligned to malaligned
  1. Preoperative results showed 30 percent of patients exhibiting malalignment, and 28 percent of patients were malaligned. Alignment was preserved in 63 percent, restored in 9 percent, not corrected in 21 percent and worsened in 7 percent.

“This is the first multicenter study to evaluate the preoperative prevalence and postoperative incidence of spinopelvic malalignment in a large series of short-segment degenerative lumbar fusions, finding over 25 percent of patients out of alignment at both time points, suggesting that alignment preservation and restoration considerations should be incorporated into the decision making of even degenerative lumbar spinal fusions,” study authors concluded.

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