After popularization of pedicle screws in the 1990’s, there has been a dramatic increase of fusion surgeries of the lumbar spine in Western countries.
A few years later, we started to see the limitations of this surgery aimed at treating degenerative disorders. Many studies, regarding for instance treatment of chronic low back pain, have shown problems related to adjacent segments degeneration for instance.
Subsequently, new implants, such as total disc replacements, have been developed in the idea of relieving biomechanical stresses on intervertebral discs adjacent to a spinal fusion. The assumption was that a rigid construct caused a mechanical overload of adjacent segments, accelerating thus their degeneration. While useful in some situations, these new technologies have also shown their limits.
In the mid 2000’s, studies on monozygotic twins, have shown that aging of the intervertebral disc was essentially genetically driven. During the same period, retrospective studies have focused on lumbar sagittal curves and pelvic parameters of patients who had undergone a spinal fusion. We became aware that many of the subjects with persistent post-operative back pain (after fusion OR disc replacement, OR even non instrumented surgeries), were characterized by an alteration of their spino-pelvic parameters. Several study groups have therefore worked to understand what were the differences, in terms of sagittal balance, between symptomatic and asymptomatic subjects.
Several groups in France were pioneers in understanding these phenomena and have developed a modern teaching of the spino-pelvic sagittal balance theory. Nowadays, any surgical therapeutic approach, be it instrumented or not, is usually prepared by a detailed analysis of sagittal balance.
One of the goals of FASTER foundation is to promote research and teaching of the sagittal balance theory, in order to offer a customized treatment to each patient and avoid or anticipate possible mechanical complications. Other research areas supported by FASTER, are spinal deformities and intervertebral disc degeneration.