World Neurosurgery: X (Apr 2023)

Relationship between lumbar lordosis, pelvic parameters, PI-LL mismatch and outcome after short fusion surgery for lumbar degenerative disease. Literature review, rational and presentation of public study protocol: RELApSE study (registry for evaluation of lumbar arthrodesis sagittal alignEment)

  • Fulvio Tartara,
  • Diego Garbossa,
  • Daniele Armocida,
  • Giuseppe Di Perna,
  • Marco Ajello,
  • Nicola Marengo,
  • Marco Bozzaro,
  • Salvatore Petrone,
  • Pietro Domenico Giorgi,
  • Giuseppe Rosario Schirò,
  • Simona Legrenzi,
  • Davide Boeris,
  • Andrea Piazzolla,
  • Anna Claudia Passarelli,
  • Alessandro Longo,
  • Alessandro Ducati,
  • Federica Penner,
  • Flavio Tancioni,
  • Alberto Bona,
  • Giovanni Paternò,
  • Cristina Tassorelli,
  • Roberto De Icco,
  • Giovanni Andrea Lamaida,
  • Enrico Gallazzi,
  • Giulia Pilloni,
  • Elena Virginia Colombo,
  • Paolo Gaetani,
  • Enrico Aimar,
  • Cesare Zoia,
  • Roberto Stefini,
  • Angelo Rusconi,
  • Amos M. Querenghi,
  • Carlo Brembilla,
  • Claudio Bernucci,
  • Andrea Fanti,
  • Alessandro Frati,
  • Antonio Manelli,
  • Vitaliano Muzii,
  • Mattia Sedia,
  • Alberto Romano,
  • Ali Baram,
  • Silvia Figini,
  • Elena Ballante,
  • Giuseppe Gioia,
  • Marco Locatelli,
  • Mauro Pluderi,
  • Carlotta Morselli,
  • Roberto Bassani,
  • Francesco Costa,
  • Fabio Cofano

Journal volume & issue
Vol. 18
p. 100162

Abstract

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Background: Vertebral arthrodesis for degenerative pathology of the lumbar spine still remains burdened by clinical problems with significant negative results. The introduction of the sagittal balance assessment with the evaluation of the meaning of pelvic parameters and spinopelvic (PI-LL) mismatch offered new evaluation criteria for this widespread pathology, but there is a lack of consistent evidence on long-term outcome. Methods: The authors performed an extensive systematic review of literature, with the aim to identify all potentially relevant studies about the role and usefulness of the restoration or the assessment of Sagittal balance in lumbar degenerative disease. They present the study protocol RELApSE (NCT05448092 ID) and discuss the rationale through a comprehensive literature review. Results: From the 237 papers on this topic, a total of 176 articles were selected in this review. The analysis of these literature data shows sparse and variable evidence. There are no observations or guidelines about the value of lordosis restoration or PI-LL mismatch. Most of the works in the literature are retrospective, monocentric, based on small populations, and often address the topic evaluation partially. Conclusions: The RELApSE study is based on the possibility of comparing a heterogeneous population by pathology and different surgical technical options on some homogeneous clinical and anatomic-radiological measures aiming to understanding the value that global lumbar and segmental lordosis, distribution of lordosis, pelvic tilt, and PI-LL mismatch may have on clinical outcome in lumbar degenerative pathology and on the occurrence of adjacent segment disease.

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