Current strategies for the restoration of adequate lordosis during lumbar fusion  

作　　者：Cédric Barrey Alice Darnis 

机构地区：[1]Department of Spine Surgery,P Wertheimer Hospital,Hospices Civils de Lyon,University Claude Bernard Lyon 1

出　　处：《World Journal of Orthopedics》2015年第1期117-126,共10页世界骨科杂志（英文版）

摘　　要：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 positioningon 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.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 positioningon 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.

关 键 词：LUMBAR LORDOSIS PELVIS shape PELVIS incidence Spinal fusion SPINE surgery SAGITTAL balance 

分 类 号：R687.3[医药卫生—骨科学]