Lordosis loss in degenerative spinal conditions.

PURPOSE: To establish whether common degenerative lumbar spine conditions have a predictable sagittal profile and associated range of lordosis. The spinopelvic balance of a normal population and normal ranges are well described in the literature. There is also evidence that certain degenerative conditions can lead to a preponderance of loss of lordosis at specific spinal levels. There is limited literature on the range and magnitude of loss of lordosis for known degenerative lumbar spine pathologies. METHODS: A retrospective analysis of prospectively obtained radiographs from a dual surgeon database was performed and imaging analysed for spinopelvic parameters. Degenerative conditions studied were; Lumbar degenerative spondylolisthesis (L3/4 and L4/5 analysed separately), L5/S1 degenerative disc disease, L5/S1 isthmic spondylolisthesis. Pelvic incidence, sacral slope, pelvic tilt, segmental and global lumbar lordosis, vertebral lordosis and lumbar vertical axis were measured. RESULTS: The range of change in segmental lordosis was normally distributed for all studied degenerative spinal conditions except L5/S1 isthmic spondylolisthesis. L5/S1 degenerative disc disease affected younger adults (mean age 37), whilst degenerative spondylolisthesis at L3/4 and L4/5 affected older adults (mean ages 69.5 and 68.9 respectively). Removing an outlying high-grade L5/S1 isthmic spondylolisthesis made the data distribution approach a normal distribution. CONCLUSION: Most degenerative spinal pathologies cause a normally distributed spectrum of deformity which should be addressed and corrected with a tailored, individualised surgical plan for each patient. Universal treatment recommendations should be interpreted with caution.

Lordosis Recreation With PLIF Surgery-What Is the Influence on Adjacent Segment Lordosis?: An Observational Study of Radiological Alignment Change.

STUDY DESIGN: Retrospective cohort. OBJECTIVE: We aimed to assess the changes in adjacent segmental lordosis (SL) across the intervertebral disc space following single level posterior lumbar interbody fusion (PLIF). SUMMARY OF BACKGROUND DATA: Adjacent segment degeneration is well documented following fusion surgery as are the spinopelvic parameters. What isn't known is the effect of fusion surgery on the adjacent SL of the lumbar spine following PLIF. METHODS: Preoperative and 1-year postoperative erect lateral radiographs were analyzed for lordotic angulation of all lumbar segments and pelvic incidence (PI) in patients undergoing L4/5 or L5/S1 PLIF. RESULTS: Fourty seven PLIFs achieved a mean of 7° increase in SL at L4/5 (P < 0.05) and 11° at L5/S1 (P < 0.05). In L5/S1 PLIF the lordosis gain was associated with lordosis reduction at adjacent segments 3° at L4/5 (P < 0.05); 1° at L3/4 (P < 0.05), 0° at L2/3(NS); 0° at L1/2(NS), and modest gain in overall lordosis (3°). At L4/5 PLIF the global lordosis increased by 5°, but less so at the adjacent discs (L5/S1 = 1°; L3/4 ≤ 1°; L2/3 ≤ -1°, and; L1/2 = <-1°). 19% of cases had a PI-LL > 10° preoperatively, reducing to 4° postoperatively. CONCLUSION: SL increased significantly at the PLIF level. At L5/S1 minimal overall lordosis change occurred however there was reduction in lordosis at adjacent levels representing reduced adjacent segment "compensation." Conversely L4/5 PLIF showed minimal change at adjacent levels but greater overall lordosis increase. Lumbar lordosis (LL) assessment requires monosegmental assessment as well as overall measure of the LL. PLIF surgery changes both LL and SL at adjacent levels. LEVEL OF EVIDENCE: 3.

The results of total hip arthroplasty for fractured neck of femur in octogenarians.

The role of total hip arthroplasty (THA) for fracture in octogenarians remains unclear. Over a two-year period, 354 patients aged > 80 years were admitted with a displaced intracapsular hip fracture. Using defined clinical guidelines, 38 patients underwent THA with a median age of 84 years, mean follow-up of 20 months. Primary outcomes were dislocation, 30-day and one-year mortality, revision surgery and periprosthetic fracture. There were no dislocations or periprosthetic fractures and patient survival was 97% at 30 days and 87% at one year. There was one revision for deep infection. This study demonstrates that THA for selected octogenarians can be performed safely, allows the majority of patients to return to independent living and has a low complication rate.