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The lumbar lordosis below Harrington instrumentation for scoliosis
S M Swank1, T M Mauri, J C Brown
1Spinal Deformity Service, Rancho Los Amigos Medical Center, Downey, California.
Insights
Harrington instrumentation for lumbar spine fusion can decrease lordosis, potentially leading to flat back syndrome. This surgical approach may cause a forward shift in the sagittal vertical axis, impacting spinal alignment.
Area of Science:
- Orthopedics
- Spinal Surgery
- Biomechanical Engineering
Background:
- Lumbar lordosis is crucial for spinal alignment and function.
- Harrington instrumentation is a surgical technique used for spinal fusion.
- Assessing the impact of spinal instrumentation on sagittal alignment is important.
Purpose of the Study:
- To evaluate changes in lumbar lordosis after Harrington instrumentation.
- To analyze the effect on unfused lumbar levels and sagittal vertical axis.
- To identify the incidence of flat back syndrome post-surgery.
Main Methods:
- Retrospective study of 43 patients.
- Pre- and post-operative measurement of lumbar lordosis.
- Assessment of lordosis in fused and unfused segments.
- Measurement of sagittal vertical axis.
Main Results:
- Progressive decrease in lordosis observed at lower fusion levels.
- Increased lordosis below the fusion did not offset overall lordosis loss.
- Sagittal vertical axis shifted anteriorly, indicating a trend towards flat back syndrome.
- The observed flat back syndrome was subtle and asymptomatic.
Conclusions:
- Harrington instrumentation can lead to a loss of lumbar lordosis.
- The compensatory lordosis below the fusion is insufficient to maintain overall spinal curvature.
- Anterior shift of the sagittal vertical axis is a potential consequence, risking flat back syndrome.
Abstract:
This retrospective study evaluates lumbar lordosis in 43 patients before and after Harrington instrumentation into the lumbar spine. The authors measured overall lumbar lordosis, lordosis of unfused lumbar levels, and sagittal vertical axis. Lordosis decreased progressively in lower levels of fusion. The increase in lordosis below the fusion did not compensate for the overall loss of lordosis. The sagittal vertical axis moved forward, producing a subtle, asymptomatic form of flat back syndrome.
