Spondylolisthesis, pelvic incidence, and spinopelvic balance.
Surgical Treatment Strategies for High-Grade Spondylolisthesis: ..
The relationship of the pelvis to the spine has previously been overlooked, and its importance in sagittal balance has been underestimated. There is a crucial interplay between structural pelvic features, spinopelvic parameters, and sagittal alignment in both normal volunteers and patients with spondylolisthesis. Although satisfactory outcomes have been reported for multiple surgical techniques in the management of spondylolisthesis, restoration of disc height, lumbar lordosis, and global sagittal balance may improve clinical recovery rates and prevent future junctional problems [9,10].
pelvic incidence, and spinopelvic balance.
The authors describe the use of sacral pedicle subtraction osteotomy (PSO) with multiple sacral alar osteotomies for the correction of sacral kyphosis and pelvic incidence and for achieving sagittal balance correction in cases of fixed sagittal deformity after a sacral fracture. In this paper, the authors report on a novel technique using a series of sacral osteotomies and a sacral PSO to correct a fixed sagittal deformity in a patient with a sacral fracture that had healed in a kyphotic position. The patient sustained this fracture after a previous surgery for multilevel instrumented fusion. Preoperative and postoperative radiographic studies are reviewed and the clinical course and outcome are presented. Experts agree that the pelvic incidence is a fixed parameter that dictates the morphological characteristics of the pelvis and affects spinopelvic orientation and sagittal spinal alignment. An increased pelvic incidence is associated with a higher degree of spondylolisthesis in the lumbosacral junction, and increased shear forces across this junction. The authors demonstrate that the pelvic incidence can be altered and corrected with a series of sacral osteotomies to improve sacral kyphosis, compensatory lumbar hyperlordosis, and sagittal balance.