Sagittal Balance of the Spine by Roussouly Pierre;Labelle Hubert;Pinheiro-Franco Joao Luiz;

Author:Roussouly, Pierre;Labelle, Hubert;Pinheiro-Franco, Joao Luiz;
Language: eng
Format: epub
Publisher: Thieme Medical Publishers, Incorporated
Published: 2019-08-15T00:00:00+00:00

Fig. 12.19 What to reduce: first the L5-S1 kyphosis, then partial slip grade reduction.

Fig. 12.20 Case example of a slip reduction in high-grade spondylolisthesis (HGS).

12.8 Conclusion

Global sagittal plane alignment is important to consider in both adult and pediatric patients with L5-S1 spondylolisthesis. Clinicians treating this disorder need to be aware that normal sagittal balance of the hip-spinopelvic axis is frequently disrupted and that it is insufficient to limit their evaluation and base their treatment plan strictly on the local L5-S1 area. Abnormal spinopelvic alignment alters the biomechanical stresses at the lumbosacral junction, and compensation mechanisms are developed to maintain an adequate posture. A classification based on sagittal alignment is proposed to help treatment decisions.

In patients with HGS associated with a postural abnormality, it is important to reduce and realign the spinal deformity, thus restoring global spinal alignment and improving the biomechanical environment for fusion. Recent evidence 26,​27,​28,​29 supports the contention that reduction of HGS improves overall global hip-spinopelvic balance by correcting the local kyphotic deformity and partly reducing vertebral slippage, and that reduction is not associated with a greater risk of developing neurologic deficits compared with arthrodesis in situ.

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