Study Design. A retrospective radiographic study. Objective. To explore the radiological parameters which correlated to postoperative immediately coronal imbalance in adult spinal deformity (ASD) and to determine whether preoperative coronal imbalance affects postoperative coronal imbalance following posterior multi-level fusion with instruments and osteotomy operation. Summary of Background Data. There was paucity of literature paying attention to the postoperative immediately coronal imbalance after operation. Methods. The study included 67 consecutive patients with ASD who underwent posterior multi-level fusion with instruments and osteotomy operation. The radiological parameters, measured on the pre- and postoperative anteroposterior and lateral radiographs, were compared and analyzed. Patients were divided into three groups (group A, B, and C) according to preoperative coronal balance distance (pre-CBD) and the relation of cervical 7 plumb line (C7PL), and the convex of curvature. To analyze the radiological parameters of the three groups. Result. Differences of the radiological parameters between pre- and postoperation concerning Cobb angles, degree of apical vertebra rotation, thoracic kyphosis (TK), thoracic lumber kyphosis (TLK), lumber lordosis (LL), sacral slope (SS), pelvic tilt (PT), and sagittal vertical axis (SVA), were significant (P < 0.05). Pelvic incidence (PI), pre-CBD, and postoperative coronal balance distance (post-CBD) had no change (P > 0.05). The ratio of coronal imbalance in pre- and postoperation was 31.34% (21/67) and 40.30% (27/67), respectively, which had significant difference (P = 0.02). Significant correlations were observed among post-CBD, pre-CBD (P < 0.001), and d-Cobb (pre-Cobb – post-Cobb) (P = 0.002), post-CBD = –2.737 – 0.924∗d-Cobb + 0.356∗pre-CBD. The ratio of postoperative immediately coronal imbalance of the group C was much higher than other two groups (P = 0.01). Conclusion. The sagittal alignments in ASD patients would be improved effectively after posterior multi-level fusion with instruments and osteotomy operation. There were significant correlations among post-CBD, pre-CBD, and d-Cobb. Patients in group C may be at greater risk for immediate postoperative coronal imbalance after operation. Level of Evidence: 3
Study Design. A retrospective radiographic study. Objectives. The aim of this study was to examine the association between global coronal alignment (GCA) and L4/L5 coronal tilt, and to verify the validity of our new index for evaluating GCA. Summary of Background Data. The mechanism of coronal imbalance is still unknown. The ability to level coronal tilts of L4 and L5 has been reported to impact the ability to achieve coronal balance, but the relationship between GCA and coronal tilt of L4 or L5 is unclear. On the contrary, although C7 migration is widely used for evaluating GCA, it has inherent defects as distance parameter. We focused on a novel global coronal angular parameter for evaluating the association of GCA with coronal tilt of L4 or L5. Methods. A total of 146 patients with adult spinal deformity were involved. The coronal measurements included C7 migration, fractional curve, L4 coronal tilt, L5 coronal tilt, major Cobb angle, and our novel global coronal parameter-coronal T1 pelvic tilt angle (CTPT, defined as the angle between a vertical line and the line connecting the middle point of S1 endplate to T1 centroid). We then determined the relationship between CTPT, C7 migration, and other coronal parameters. Results. C7 migration had significant correlation with L4 coronal tilt, L5 coronal tilt or fractional curve, but not with major Cobb angle. CTPT resembled C7 migration regarding its relationships with L4 coronal tilt, fractional curve, L5 coronal tilt and major Cobb angle. Regression analysis showed CTPT strongly associated with C7 migration (R 2 = 0.985), CTPT = 0.02+0.14∗ C7 migration and neither L4 coronal tilt nor L5 coronal tilt was an independent predictor of GCA. Conclusion. CTPT could be a practical index for evaluating GCA. Neither L4 coronal tilt nor L5 coronal tilt was an independent predictor of GCA. Level of Evidence: 3
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