Rouen university hospital, Spine Unit, Department of orthopaedic surgery, 76000 Rouen, France.
Rouen university hospital, Spine Unit, Department of orthopaedic surgery, 76000 Rouen, France.
Orthop Traumatol Surg Res. 2020 Oct;106(6):1195-1201. doi: 10.1016/j.otsr.2020.02.013. Epub 2020 Apr 21.
Anterior lumbar interbody fusion finds a place in L5-S1 isthmic spondylolisthesis (ISPL) treatment. Extension of this arthrodesis at L4-L5 level is sometimes required. Anterior approach of the L4L5 disc is considered difficult due to the anatomical relationship between the iliocava junction (ICJ) and the spine.
Does the lumbosacral deformation induced by ISPL allows anterior approach of L4-L5 disc between the iliac?
Retrospective radiographic analysis of consecutive patients.
This retrospective imaging study of a continuous series of 97 patients treated for an L5-S1 ISPL involved radiological parameters specific to ISPL and pelvic-sagittal balance. The distance between the ICJ and the L4 lower endplate was measured in millimeters. The factors influencing this distance were sought in order to identify a predictive model of high ICJ.
The ICJ took a cranial position with respect to the L4-L5 disc with an average distance of 1.8mm±16.4. This distance was statistically higher in the case of high-grade ISPL (p<0.01). The high ICJ position was correlated with a high Taillard index (r=0.39; CI [0.13; 0.61]; p<.001) and a low lumbar-sacral angle (LSA) (r=-0.33; CI [-0.56; -0.06]; p<0.01). Among the parameters specific to spino-pelvic statics, pelvic incidence, pelvic tilt and lumbar lordosis had similar correlations (r>0.30).
ISPL induces a geometric deformation of the lumbosacral hinge which modifies its anatomical relations with the ICJ. The anterior approach technique of L4-L5 disc in the presence of an L5-S1 ISPL is possible between the iliac veins for the large displacement and low LSA forms.
IV, retrospective analysis.
前路腰椎体间融合术在治疗 L5-S1 峡部裂性滑脱（ISPL）中具有一定的地位。有时需要在 L4-L5 水平进行关节融合。由于髂腔交界处（ICJ）与脊柱之间的解剖关系，前路 L4-L5 椎间盘的方法被认为具有一定难度。
ISPL 引起的腰骶部变形是否允许在髂骨之间进行 L4-L5 椎间盘的前路手术？
连续患者的回顾性影像学分析。
本回顾性影像学研究连续纳入了 97 例接受 L5-S1 ISPL 治疗的患者，研究涉及 ISPL 特有的放射学参数和骨盆矢状平衡。以毫米为单位测量 ICJ 与 L4 下终板之间的距离。寻找影响此距离的因素，以确定高 ICJ 的预测模型。
ICJ 相对于 L4-L5 椎间盘处于颅侧位置，平均距离为 1.8mm±16.4mm。在高度 ISPL 的情况下，这个距离具有统计学意义（p<0.01）。高 ICJ 位置与高 Taillard 指数（r=0.39；CI [0.13；0.61]；p<.001）和低腰椎骶骨角（LSA）（r=-0.33；CI [-0.56；-0.06]；p<0.01）相关。在脊柱骨盆静态特定参数中，骨盆入射角、骨盆倾斜角和腰椎前凸角具有相似的相关性（r>0.30）。
ISPL 引起腰骶关节的几何变形，改变了其与 ICJ 的解剖关系。对于大位移和低 LSA 形式的 L5-S1 ISPL 患者，L4-L5 椎间盘前路技术在髂骨之间是可行的。
IV，回顾性分析。
