Analysis of unfavorable postoperative outcomes in patients with lumbosacral junction anomalies

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BACKGROUND

The absence of a unified diagnostic approach and heterogeneous treatment strategies in patients with lumbosacral transitional vertebra contribute to registration of contradictory data on postoperative outcomes in these patients.

OBJECTIVE

A retrospective analysis of postoperative outcomes in patients with degenerative lumbar spine diseases associated with lumbosacral junction anomalies and causes of unfavorable results.

MATERIAL AND METHODS

Lumbosacral transitional vertebra was preoperatively verified and classified according to Castellvi A.E. in 352 cases between 2007 and 2017. Full-time examination, phone and e-mail survey covered 314 (89.2%) patients throughout 5.2-year follow-up period. There were unfavorable clinical outcomes in 42 cases. We analyzed the causes of these results and relationship of surgical strategy with the type of lumbosacral junction anomaly.

RESULTS

Lumbosacral transitional vertebra Castellvi type IIA (30.9%) and IIIA (34.9%) prevailed. Unfavorable outcomes occurred in 7 cases after percutaneous interventions, in 12 patients after decompression surgery and in 23 patients after decompression and stabilization procedures. In all cases (n=42), redo surgery was performed: rigid fixation or extension of stabilization system in 16 cases, additional intracanal decompression in 10 patients, foraminal/extraforaminal decompression in 8 patients. Seven patients underwent repeated laser denervation. Of these, 5 patients underwent dorsal decompression without discectomy due to ineffective denervation. Correlation analysis showed the relationship between unfavorable outcomes after percutaneous procedures with L_V transverse process dysplasia and sacralization, decompressive interventions with additional articular joints and lumbarization, decompression/stabilization procedures with L_V transverse process dysplasia and sacralization.

CONCLUSION

Unfavorable outcomes occurred after percutaneous interventions for anomaly type IB and IIIB, decompressive procedures for anomaly type IIA, IIB and IV, decompression/ stabilization procedures for types IA and IIIA. It is the first report devoted to analysis of relationships between unsatisfactory postoperative outcomes, surgical technique and type of lumbosacral dysgenesis.

Keywords:

lumbar spine

degenerative diseases

lumbosacral anomalies

lumbosacral transitional vertebra

lumbarization

sacralization

diagnosis

surgical treatment

unfavorable outcomes

Authors:

Byvaltsev V.A.

Irkutsk State Medical University;
Private Healthcare Institution «Clinical Hospital «Russian Railways-Medicine»;
Irkutsk State Medical Academy of Postgraduate Education

Kalinin A.A.

Irkutsk State Medical University;
Private Healthcare Institution «Clinical Hospital «Russian Railways-Medicine»

Biryuchkov M.Yu.

Marat Ospanov West Kazakhstan Medical University

Khozeev D.V.

Irkutsk State Medical University

Dzhubayeva B.A.

Marat Ospanov West Kazakhstan Medical University

Pestryakov Yu.Ya.

Irkutsk State Medical University

Received:

09.03.2021

Accepted:

29.11.2021

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