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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2015; 6(1): 117-126
Published online Jan 18, 2015. doi: 10.5312/wjo.v6.i1.117
Current strategies for the restoration of adequate lordosis during lumbar fusion
Cédric Barrey, Alice Darnis
Cédric Barrey, Alice Darnis, Department of Spine Surgery, P Wertheimer Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, 69003 Lyon, France
Author contributions: Barrey C and Darnis A contributed equally to this work.
Open-Access: This article is an open-access article which selected by an in-house editor and fully peer-reviewed by external reviewers. It distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Cédric Barrey, MD, PhD, Department of Spine Surgery, P Wertheimer Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1, 59 Boulevard Pinel, 69003 Lyon, France. c.barrey@wanadoo.fr
Telephone: +33-6-86940037 Fax: +33-4-72357262
Received: December 30, 2013
Peer-review started: December 31, 2013
First decision: March 12, 2014
Revised: July 14, 2014
Accepted: July 27, 2014
Article in press: July 29, 2014
Published online: January 18, 2015
Processing time: 386 Days and 8.1 Hours
Abstract

Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 segment and 85% by the L3-S1 segment. Technical aspects involve patient positioning on the operating table, release maneuvers, type of instrumentation used (rod, screw-rod connection, interbody cages), surgical sequence and the overall surgical strategy. Spinal osteotomies may be required in case of fixed kyphotic spine. AP combined surgery is particularly efficient in restoring lordosis at L5-S1 level and should be recommended. Finally, not one but several strategies may be used to achieve the need for restoration of adequate lordosis during fusion surgery.

Keywords: Lumbar lordosis; Pelvis shape; Pelvis incidence; Spinal fusion; Spine surgery; Sagittal balance

Core tip: Not restoring the adequate lumbar lordosis during fusion surgery may result in mechanical pain, sagittal unbalance and adjacent segment degeneration. The objective of this paper is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. The amount of lordosis to restore can be precisely evaluated from the analysis of spino-pelvic parameters. Technical tools during surgery involve patient positioning, release maneuvers, type of instrumentation used and surgical sequence. Finally, not one but several strategies may be used to restore the adequate lordosis during fusion surgery.