Article Figures & Data
Figures
- Figure 1
Lumbar and pelvic spinal alignment measurements.
- Figure 2
Clinical outcome at last follow-up (average 33 months, range 18–56 months, n = 27): (a) patient's satisfaction with the clinical outcome; (b) Oswestry Disability Index (ODI) (1–100) score.
- Figure 3
A case study demonstrating the limitations of a single-disc replacement in correcting a spinal flat-back deformity: (a–c) a 45-year-old obese male patient underwent posterolateral fusion in 1998 and had significant mechanical back and leg pain thereafter; he presented with bilateral foot drop and severe low-back pain 5 years later; (d–g) after junctional disc replacement the patient was doing well during follow-up until 2 years after the index surgery; (h) at 26 months post-index surgery the patient re-presented with spinal stenosis, a rightsided foot drop, and severe low-back pain; radiographs showed extended disc prosthesis and myelography confirmed spinal stenosis behind disc prosthesis; (i, j) after double osteotomy (OT) (pedicle substraction OT L5 and multiple lower thoracic OTs as well as a direct posterior decompression L3–L4), rebalancing of the prosthetic disc and complete relief from symptoms.
- Figure 4
Lumbar and pelvic parameters determined preoperatively and at latest follow-up.
- Figure 5
Changes in sacral tilt in relation to clinical outcome: (a) sacral tilt and satisfaction with surgical outcome; (b) sacral tilt and pain score; (c) sacral tilt and Oswestry Disability Index (1–100) score.
- Figure 6
Changes in sacral tilt in correlation to clinical outcome: (a) pelvic tilt and satisfaction with surgical outcome; (b) pelvic tilt and pain score; (c) pelvic tilt and Oswestry Disability Index (ODI) (1–100) score.
Tables
No. or Mean ± SD (n = 27) Male, no. 14 Age, mean ±SD, y 49.2 ±9.3 Height, mean ±SD, cm 171.2 ±8.3 Weight, mean ±SD, kg 80.7 ±17.6 Pain duration, mean ±SD, mo 51.1 ±58.1 Nonoperative care Physiotherapy 25 Chiropractic care 15 Acupuncture 7 Previous surgeries Discectomy 12 Laminectomy 23 Posterolateral fusion procedures 33 Posterolateral interbody fusion 1 Levels fused preoperatively 1 18 2 8 3 0 4 1 Smokers 13 Preoperative employment status Employed 19 Not employed 3 Disabled 2 Retired 3 Claim or compensation patients 2 Mean ±SD Operative time, all patients, min 134 ±80 Estimated blood loss, mL 290 ±335 Dorsal-ventral-dorsal surgery/OT surgery, no. (n = 27) 4 Hospital stay, all patients, days 3.3 (1.1) Note. OT = osteotomy.
Time After Index Surgery Problem Treatment Applied Patient 1: 2 days Incomplete recess decompression Removal of prosthesis, decompression, reinsertion of same prosthesis Patient 2: 10 mo Recurrent mechanical stenosis symptoms because of persistent flat back after disc prosthesis at L3–L4 Disc replacement L5–S1 + anterior cage at posterior fused L4–L5 Patient 3: 26 mo Recurrent mechanical stenosis symptoms because of persistent flat back after disc prosthesis at L3–L4 Double posterior osteotomy (OT) (pedicle substraction OT L5 and multiple, limited OTs T9–L1) Additional thoracic kyphosis of 74° See Figure 3 Patient 4: 41 mo Persistent flat-back deformity and progressive instability at disc level with sciatica and low-back pain Exchange prosthesis L4–L5 for higher-angled prosthesis of different make Note. OT = osteotomy.
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