Correlação entre a gravidade da doença degenerativa lombar e o alinhamento espinopélvico

Pratali, Raphael de Rezende; Battisti, Raphael; Oliveira, Carlos Eduardo Algaves Soares de; Maranho, Daniel A; Herrero, Carlos Fernando Pereira da Silva

doi:10.1055/s-0041-1729579

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…The implications of abnormal spinopelvic alignment in degenerative lumbar pathologies have been recently investigated 6-10 . Patients with higher pelvic incidence (PI) are more prone to experiencing lumbar spondylolisthesis, and those with extremely high PI values have a greater likelihood of developing 2-level disease 10-20 .…”

Section: Sagittal Alignment and Degenerative Lumbar Pathologiesmentioning

confidence: 99%

Sagittal Alignment in the Degenerative Lumbar Spine

Diebo,

Balmaceno-Criss,

Lafage

et al. 2024

Journal of Bone and Joint Surgery

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➤ Sagittal alignment of the spine has gained attention in the field of spinal deformity surgery for decades. However, emerging data support the importance of restoring segmental lumbar lordosis and lumbar spinal shape according to the pelvic morphology when surgically addressing degenerative lumbar pathologies such as degenerative disc disease and spondylolisthesis.➤ The distribution of caudal lordosis (L4-S1) and cranial lordosis (L1-L4) as a percentage of global lordosis varies by pelvic incidence (PI), with cephalad lordosis increasing its contribution to total lordosis as PI increases.➤ Spinal fusion may lead to iatrogenic deformity if performed without attention to lordosis magnitude and location in the lumbar spine.➤ A solid foundation of knowledge with regard to optimal spinal sagittal alignment is beneficial when performing lumbar spinal surgery, and thoughtful planning and execution of lumbar fusions with a focus on alignment may improve patient outcomes.

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Section: Sagittal Alignment and Degenerative Lumbar Pathologiesmentioning

confidence: 99%

Sagittal Alignment in the Degenerative Lumbar Spine

Diebo,

Balmaceno-Criss,

Lafage

et al. 2024

Journal of Bone and Joint Surgery

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“…Sagittal alignment should be understood as an interaction between the shape and orientation of the spine and pelvis 1,2 . There has been increasing concern about the importance of the sagittal plane contour in the evaluation and treatment of spinal pathologies 3–9 . Several studies have shown that progression of adolescent idiopathic scoliosis (AIS) alters spinopelvic sagittal balance and leads to specific sagittal alignment in these people 10–14 .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 There has been increasing concern about the importance of the sagittal plane contour in the evaluation and treatment of spinal pathologies. [3][4][5][6][7][8][9] Several studies have shown that progression of adolescent idiopathic scoliosis (AIS) alters spinopelvic sagittal balance and leads to specific sagittal alignment in these people. [10][11][12][13][14] Moreover, further studies have evaluated sagittal alignment in adolescents according to their coronal curve types.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Sagittal Alignment in Patients with Severe and Rigid Scoliosis

Zhang

Wang

et al. 2023

Orthopaedic Surgery

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Objective: There has been increasing concern about the importance of sagittal alignment in the evaluation and treatment of spinal scoliosis. However, recent studies have only focused on patients with mild to moderate scoliosis. To date, little is known about the sagittal alignment in patients with severe and rigid scoliosis (SRS). This study was performed to evaluate the sagittal alignment in patients with SRS, and to analyze how it was altered after corrective surgery. Methods:In this retrospective cohort study, we included 58 patients with SRS who underwent surgery from January 2015 to April 2020. Preoperative and postoperative radiographs were reviewed, and the sagittal parameters mainly included thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacrum slope (SS), and sagittal vertical axis (SVA). The sagittal balance state was evaluated according to whether the PI minus the LL (PI-LL) was less than 9 , and the patients were divided into thoracic hyperkyphosis and normal groups based on whether the TK exceeded 40 . The Student's t test, Pearson's test, and Receiver operating characteristic (ROC) curve analysis were used to compare related parameters between the different groups. Results:The mean follow-up duration was 2.8 years. Preoperatively, the mean PI was 43.6 AE 9.4 , and the mean LL was 65.2 AE 13.9 . Sixty-nine percent of patients showed sagittal imbalance, and they showed larger TK and LL values and smaller PI and SVA values than those with sagittal balance. Additionally, most patients (44/58) presented with thoracic hyperkyphosis; this group had smaller PI and SVA values than the normal patients. Patients with syringomyelia-associated scoliosis were more likely to present with thoracic hyperkyphosis. The TK and LL values were significantly decreased, and 45% of patients with preoperative sagittal imbalance recovered after surgery. These patients had a larger PI (46.4 AE 9.0 vs 38.3 AE 8.8 , P = 0.003) and a smaller TK (25.5 AE 5.2 vs 36.3 AE 8.0 , P = 0.000) at the final follow-up. Conclusion:Preoperative sagittal imbalance appears in the majority of SRS patients, accounting for approximately 69% of our cohort. Patients with small PI values or syringomyelia-associated scoliosis were more likely to present with thoracic hyperkyphosis. Sagittal imbalance can generally be corrected by surgery, except in patients with a PI less than 39 . To achieve good postoperative sagittal alignment, we recommend controlling the TK to within 31 .

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