Open AccessCurrent strategies for the restoration of adequate lordosis during lumbar fusion
Author(s) -
Cédric Barrey
Publication year - 2015
Publication title -
world journal of orthopedics
Language(s) - English
Resource type - Journals
ISSN - 2218-5836
DOI - 10.5312/wjo.v6.i1.117
Subject(s) - medicine , lordosis , lumbar lordosis , sagittal plane , lumbar , spinal fusion , surgery , radiography , anatomy
Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery.