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Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C.

2023, Number 3

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Cir Columna 2023; 1 (3)

Advantages of sacral biomechanical integrity during lumbar and thoracolumbar fusion in patients without L5-S1 segment pathology

Marina GA, Jiménez ÁJM

Language: Spanish
References: 30
Page: 158-167
PDF size: 209.95 Kb.


ABSTRACT

Introduction: we consider that the lumbar spine is part of a structural gear as it is located in the pelvis and supported by the sacrum and coccyx. The angulation of the sacrum provides an inclined base of support for the lumbar spine. It highlights the importance of the muscles not only of the back but also those of the pelvis, abdomen and legs in the biomechanical maintenance of posture and stability of the spine. A higher pelvic incidence implies an increase in the sacral slope, resulting in a greater lumbar lordosis. Multisegmental lumbar fusion significantly limits lumbar mobility and affects the ability to compensate for postural changes. Reducing fusion segments as much as possible is of particular value to preserve lumbar mobility and maintain the compensatory mechanism of the spinopelvis. Material and methods: a search was performed in four different databases with the keywords, looking for articles related to the advantages and disadvantages of instrumentation and thoracolumbar fusion and short lumbar fusion with termination in the L5 segment between 2000 and 2023, 25 articles were included. Conclusions: finding a healthy and biomechanically integral L5-S1 segment, there are biomechanical and surgical advantages that help contribute to better results and fewer complications in short lumbar and thoracolumbar fusions. It is recommended to properly select patients who plan to avoid L5-S1 fusion especially during long fusions and strive for optimal postoperative results in spinopelvic parameters and good correction of the postoperative fractional curve. Selection features include: L5-S1 disc height preservation, good sagittal balance, preserved lumbar lordosis, pelvic incidence (PI) > 48.5°, sagittal vertical axis (SVA) < 4.43 cm and sacrum-femoral distance (SFD) < 5.65 cm.


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