Arthrodèses lombaires antérieures L5-S1 isolées : facteurs de risque de faillite mécanique et de survenue d’une pseudarthrodèse lombo-sacrée

Abstract : L5-S1 stand-alone ALIF is a reliable technique to treat symptomatic degenerative disc disease but remains controversial to treat isthmic spondylolisthesis. The objectives were, to identify risk factors of instrumentation failure and pseudarthrosis after stand-alone L5-S1 anterior lumbar interbody fusion (ALIF) and, to evaluate if instrumentation failure influenced the rate of fusion. Sixty-four patients (22 male patients (34.4%); 42 (65.6%) female patients) with stand-alone L5-S1 ALIF were included with a mean age at 46.4 years (range, 21 to 65 years) using radiolucent anterior cages with vertebridge® plating fixation in each vertebral endplate. Clinical and radiographic data were reviewed, including age, gender, pelvic parameters, the Segmental Sagittal Angle (SSA), C7 Barrey ratio, C7 sagittal tilt, lumbar lordosis (LL), segmental LL, percentage of L5 slippage, the L5-S1 disc angle and the posterior disc height ratio. Univariate and multivariate analysis used to identify risk factors of instrumentation failure and pseudarthrosis. At a mean follow-up of 15.6 months (range 3.9 – 27.4 months), 57 patients (89.1%) have fused. Instrumentation failure was found in 12 patients (18.8%) and pseudarthrosis in 7 patients (10.9%). The following parameters influenced the occurrence of instrumentation failure: the presence of an isthmic spondylolisthesis (p<0.001), the grade of the spondylolisthesis (p<0.001), the use of iliac crest bone autograft (p=0.04) , the important height of the cage (p=0.03), the importance of the Pelvic Incidence (PI) (p<0.001), Sacral Slope (SS) (P<0.001), SSA (p=0.003) and LL (p<0.001). Instrumentation failure was statistically linked to the occurrence of L5-S1 pseudarthrosis (p<0.001). On multi analysis, no risk factor has been found. L5-S1 isthmic spondylolisthesis and high PI seems to be risk factors of instrumentation failure in case of standalone L5-S1 ALIF advocating the necessity to add a percutaneous posterior pedicle screw instrumentation in this case.
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Master Thesis
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Antoine Jaeger. Arthrodèses lombaires antérieures L5-S1 isolées : facteurs de risque de faillite mécanique et de survenue d’une pseudarthrodèse lombo-sacrée. Médecine humaine et pathologie. 2018. ⟨dumas-02059367⟩

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