European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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The role of the pelvic area in sagittal balance is evident for spinal surgeons, but the influence of the coxofemoral joint is underestimated and inadequately explained by conventional imagery. Comprehensive analysis of the pelvic and subpelvic sectors as part of the sagittal, frontal and cross-sectional balance of the trunk sheds new light on some spinal diseases and their relation to the pelvis. ⋯ A comprehensive assessment of each patient and in particular of the complex comprising the spine and the pelvis, is essential for understanding each individual's adaptation to the imbalance induced by disorders of the spine or lower limbs.
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Comparative Study Clinical Trial
Sagittal balance parameters influence indications for lumbar disc arthroplasty or ALIF.
Chronic lower back pain is a potentially incapacitating condition associated with disc degeneration. Although therapy is primarily pharmaceutical, surgery comprising arthrodesis constitutes an alternative. Anterior intersomatic lumbar arthrodesis (ALIF, anterior interbody lumbar fusion) is the reference approach, although total disc arthroplasty may also be undertaken. Analysis of pelvic and spinal parameters provides the best indication of sagittal balance. ⋯ The pre-operative SSA value for the study population was 126.09° ± 8.45° and the mean spine tilt angle was 90° compared with 95° in healthy subjects. Following surgery, the SSA was considerably increased in the discal arthroplasty, resulting in a significantly more balanced spinal position. In the group of patients undergoing arthrodesis using the ALIF technique, no such significant improvement was found despite the use of a lordosis cage. We showed that in cases of low pelvic incidence, it was necessary to maintain a Roussouly type 1 or 2 back without increasing lordosis. The results demonstrated the value of L4-L5 disc prostheses in these subjects. L5-S1 arthrodesis seemed a more suitable approach for treating patients with elevated sacral slope (back type 3 or 4). This new type of analysis of sagittal parameters should be performed prior to all surgical procedures involving lumbar prostheses.
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Randomized Controlled Trial
Cervical spondylotic myelopathy: conservative versus surgical treatment after 10 years.
It is not known whether the results of decompressive surgery to treat the mild and moderate forms of spondylotic cervical myelopathy (CSM) are any better than those of a conservative approach. A 10-year prospective randomised study was performed. The objective of the study was to compare conservative and operative treatments of mild and moderate, non-progressive, or slowly progressive, forms of CSM. ⋯ In both groups, patients get better and worse. According to the power analysis it is necessary admit that these results possess the low ability to answer definitely the question which treatment is better for the patients with a mild and moderate non-progressive CSM because of the low number of patients for the final evaluation and for clinically negligible differences between two compared arms. These findings can serve as a worthy odds-on hypothesis which needs the confirmation.
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Comparative Study
Correlation of clinical outcome and spinopelvic sagittal alignment after surgical treatment of low-grade isthmic spondylolisthesis.
The aim of this prospective study was to assess the sagittal alignment of the spine and pelvis before and after surgical treatment of isthmic spondylolisthesis with flat sacrum. At the same time, the functional outcome was analyzed and correlation examined. ⋯ Surgical management of low- and mid-grade isthmic spondylolisthesis showed good clinical outcome with restoration of correct values for the pelvic position-dependent parameters, i.e., pelvis tilt, sacral slope, C7 plumb line position and SSA.
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Comparative Study
Comparison of Nurick grading system and modified Japanese Orthopaedic Association scoring system in evaluation of patients with cervical spondylotic myelopathy.
The purpose of this study was to determine the correlation between Nurick grade and modified Japanese Orthopaedic Association (mJOA) scores in the preoperative and postoperative follow-up evaluation of patients with cervical spondylotic myelopathy (CSM). This retrospective study included 93 patients with CSM who underwent central corpectomy (CC) between 1998 and 2008. Preoperative and postoperative Nurick grade and total mJOA (tmJOA) and lower limb mJOA (llmJOA) score of each patient was documented and the correlation between the Nurick grades and the mJOA scores was studied. ⋯ Although Nurick grade and llmJOA had good correlation preoperatively, at follow-up evaluation after surgery, there was disagreement in 11.8% (11/93) patients. One of the major reasons for the discrepancy between the Nurick scale and the llmJOA at follow-up evaluation was the ability of patients to regain employment without an improvement in the llmJOA score. As disease-specific scales, both Nurick scale and mJOA score should be utilized in the evaluation of patients with CSM.