Understanding and Addressing Degenerative Spinal Deformity: A Comprehensive Guide

This issue of Neurosurgery Clinics, expertly edited by Drs. Sigurd Berven and Praveen V. Mummaneni, delves into the critical topic of Degenerative Spinal Deformity, focusing on the creation of lordosis in the lumbar spine. This comprehensive guide covers a wide range of topics, including:

Spinopelvic Parameters

Understanding the spinopelvic parameters is crucial for addressing degenerative spinal deformity. These parameters include pelvic incidence, sacral slope, and lumbar lordosis, which are essential for maintaining spinal balance and preventing further deformity.

Location of Lordosis and Age Adjustments

The location and degree of lordosis can significantly impact the success of spinal deformity correction. The priority for creating lordosis typically lies between L4 and S1, with adjustments necessary based on the patient’s age and specific spinal condition.

Approach Selection

The choice of surgical approach is critical in addressing degenerative spinal deformity. Options include anterior, posterior, and lateral approaches, each with its own set of advantages and challenges. The selection of the appropriate approach depends on various factors, including the extent and location of the deformity, as well as the patient’s overall health.

Nuances of Pedicle Subtraction Osteotomy

Pedicle subtraction osteotomy (PSO) is a powerful tool in the correction of spinal deformity. It involves the removal of a wedge of bone from the vertebra, allowing for the correction of sagittal plane deformities. However, PSO requires meticulous planning and execution to avoid complications and ensure optimal outcomes.

Preventing Pseudarthrosis and PJK

Pseudarthrosis and proximal junctional kyphosis (PJK) are common complications following spinal fusion surgery for deformity correction. Prevention strategies include meticulous surgical technique, adequate bone preparation, and the use of bone graft substitutes. Postoperative management also plays a crucial role in preventing these complications.

The Challenge of Creating Lordosis in High Grade Dysplastic Spondylolisthesis

High-grade dysplastic spondylolisthesis presents a unique challenge in creating lordosis. This condition often requires a combination of anterior and posterior approaches, as well as the use of specialized instrumentation to achieve optimal correction and stability.

Sacropelvic Fixation

Sacropelvic fixation is essential for maintaining spinal stability and preventing further deformity, particularly in cases involving long fusions. This can be achieved through the use of iliac screws, S2-alar-iliac (S2AI) screws, or other specialized fixation techniques.

Evolution of the MISDEF Algorithm

The MISDEF (Minimally Invasive Spinal Deformity Surgery) algorithm has evolved significantly over the years, providing surgeons with a more nuanced approach to addressing spinal deformity. This algorithm takes into account various factors, including the patient’s age, the extent of the deformity, and the surgeon’s preference, to guide the selection of the most appropriate surgical approach.

Transpsoas Approach Nuances

The transpsoas approach offers a minimally invasive option for accessing the lumbar spine. This approach requires a thorough understanding of the anatomy and careful planning to avoid complications, such as nerve damage or vascular injury.

Lateral Prepsoas Approach Nuances

The lateral prepsoas approach provides an alternative to the transpsoas approach, allowing for the correction of spinal deformity through a more lateral trajectory. This approach also requires meticulous planning and execution to ensure optimal outcomes.

Anterior Column Release

Anterior column release is a critical step in the correction of spinal deformity, particularly in cases involving severe sagittal plane deformities. This procedure involves the release of the anterior longitudinal ligament and the intervertebral discs to allow for the correction of the deformity.

Navigation Assisted MIS Deformity Correction

Navigation technology has significantly enhanced the accuracy and efficiency of minimally invasive spinal deformity correction. This technology allows surgeons to precisely place instrumentation and correct the deformity in real-time, reducing the risk of complications and improving patient outcomes.

MIS TLIF

Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) offers a less invasive alternative to traditional open TLIF. This procedure involves the insertion of a spinal implant through a small incision, reducing tissue damage and promoting faster recovery.

MIS PSO

Minimally invasive pedicle subtraction osteotomy (MIS PSO) combines the benefits of PSO with the advantages of minimally invasive surgery. This approach allows for the correction of sagittal plane deformities through smaller incisions, reducing the risk of complications and promoting faster recovery.

The Challenge of L4-S1 Fractional Curves

L4-S1 fractional curves present a unique challenge in spinal deformity correction. These curves require a combination of anterior and posterior approaches, as well as the use of specialized instrumentation, to achieve optimal correction and stability.