Perbedaan Parameter Spinopelvik Sebelum dan Sesudah Fusi Spinal Posterior pada Pasien Stenosis Spinal Lumbosakral di RSUP H Adam Malik Medan

Abstract

Introduction: Fusion and instrumentation during decompression surgery are suggested to reduce pain and overcome instability. However, spinal fusion also has some consequences as fusion changes the normal biomechanics of the spine and reduces spinal mobility. Evaluation of spinopelvic balance after posterior spinal fusion has not been widely studied. Therefore, the purpose of this study was to assess spinopelvic balance in adult patients who had been diagnosed with lumbosacral spinal stenosis and received spinal fusion procedures. Methods: This analytical study, using a pre-test and post-test design, was conducted from August to September 2022. The study population was patients with more than 40 years old who had been diagnosed with lumbosacral spinal stenosis and underwent spinal fusion at H. Adam Malik Hospital Medan in 2017-2021. Inclusion criteria were patients who had a lumbosacral x-ray before surgery, < 6 months after surgery, and > 6 months after surgery, and the lumbosacral x-ray is visible until the hip joint, and those lumbosacral spinal stenosis underwent spinal fusion. Exclusion criteria were incomplete data and implant failure after spinal fusion. The dependent t test or Mann-U-Whitney test was used to assess the statistical analysis. Results: There were 22 samples included in this study. A total of 22 patients, The age ranged from 50-68 years old, with mean age of 59.48 ± 9.08 years old. There were more female samples (68.2%) than males (31.8%). Pelvic tilt mean angle were 19.140 ± 22.280 vs 17.68 ± 8.020 vs 14.270 ± 5.340. Sacral slope mean angle were 43.230 ± 20.220 vs 17.680 ± 8.020 vs 14.270 ± 5.340. Pelvic incidence mean angle were 57.680 ± 11.560 vs 55.590 ± 12.280 vs 52.640 ± 10.050. Lumbar lordosis mean angle were 43.910 ± 13.020 vs 41.550 ± 12.770 vs 41.18 ± 13.120. Pelvic incidence lumbar lordosis mismatch mean angle were 14.860 ± 10.260 vs 14.500 ± 10.790 vs 11.230 ± 8.550. The analysis showed changes in angles among the three groups in all evaluated spinopelvic parameters, but not statistically significant (p>0.05). Discussion: Previous research. indicated that spinopelvic examinations such as lumbar lordosis, pelvic incidence, and pelvic tilt were highly correlated with sagittal balance, where pelvic incidence was a particularly important key parameter. In this study, spinopelvic parameters in three groups were examined, compared and evaluated at three different times, yielding no significant differences. The pelvic incidence lumbar lordosis mismatch is an important parameter to examine. However, the results of this study did not show any significant differences among the values before and after posterior spinal fusion surgery. Conclusions: There was no significant differences in spinopelvic parameters before posterior spinal fusion, < 6 months, and > 6 months after posterior spinal fusion surgery in patients with lumbosacral spinal stenosis.