A new classification for coronal malalignment in adult spinal deformity: a validation and the role of lateral bending radiographs

Hayashi, Kazunori; Boissière, Louis; Cawley, Derek; Larrieu, Daniel; Kieser, David; Berjano, Pedro; Lamartina, Claudio; Gupta, Munich; Silvestre, Clément; Protopsaltis, Themi S.; Bourghli, Anouar; Pellisé, Ferràn; Annis, Prokopis; Papadopoulos, E.; Kreichati, Gaby; Pizones, Javier; Nakamura, Hiroaki; Ames, Christopher P.; Obeid, Ibrahim

doi:10.1007/s00586-020-06513-5

“…Recent literature demonstrated that sagittal and coronal malalignment may be interconnected. 4,[12][13][14] The importance of including the cranium in alignment assessments, such as OD-CVA and ORB-CVA, is increasingly recognized. 8 Three simple, user-friendly cranial plumb line parameters: OD-L5, ORB-L5, and C7-L5, were used to assess CM's relationship with outcomes.…”

Section: Discussionmentioning

confidence: 99%

Practical Methods of Assessing Coronal Alignment and Outcomes in Adult Spinal Deformity Surgery

Shen,

Sardar,

Greisberg

et al. 2023

Spine

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Study Design. Asymptomatic cohort: prospective, cross-sectional, multi-center. Symptomatic: retrospective, multi-surgeon, single-center. Objective. To assess the association between cranial coronal alignment and adult spinal deformity (ASD) surgical risk and outcomes. Summary of Background Data. ASD leads to decreased quality of life. Studies have shown that coronal malignment (CM) is associated with worse surgical outcomes. Methods. 468 adult participants were prospectively enrolled in the asymptomatic cohort. 172 symptomatic ASD patients with 2-year follow-ups were retrospectively enrolled in the symptomatic cohort. Three cranial plumb line parameters: the positions of the plumb lines from the midpoint between the medial orbital rims (ORB-L5), the odontoid (OD-L5), and the C7 centroid (C7-L5) relative to the L5 pedicle, were measured. Each subject had plumb line medial (M), touching (T), or lateral (L) to either pedicle. The association between each group of patients and radiographic parameters, intraoperative variables, patient-reported outcomes (PROs), and clinical outcomes were analyzed. Results. In the asymptomatic cohort, OD-L5 was medial to or touching the L5 pedicle in 98.3% of volunteers. In the symptomatic patients, preoperative OD-L5-L exhibited higher mean age (56.2±14.0), odontoid-coronal vertical axis (OD-CVA) (5.5±3.3 cm), Oswestry Disability Index (ODI) score (40.6±18.4), pelvic fixation rate (56/62, 90.3%), OR time (528.4±144.6 min), median estimated blood loss (EBL) (1300cc), and durotomy rate (24/62, 38.7%). A similar pattern of higher CVA, preoperative ODI, intraoperative pelvic fixation rate, OR time, EBL, and durotomy rate was observed in ORB-L5-L and C7-L5-L patients. Final follow-up postoperative OD-L5-L was associated with higher rates of proximal junctional kyphosis (PJK) (13.0%) and pseudarthrosis (17.4%). Conclusion. Preoperative OD-L5, ORB-L5, and C7-L5 lateral to pedicles were associated with worse preoperative ODI and higher intraoperative complexity. Postoperative OD-L5-L was associated with higher rates of PJK and pseudarthrosis. Postoperative CM, approximated by cranial plumb line lateral to the L5 pedicles, was associated with sagittal plane complications.

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“…The statement in the introduction of the authors’ paper that it is unknown whether the Obeid-Coronal Malalignment (O-CM) classification is feasible or not is not true because after the initial paper was published, a validation study for the classification involving 15 spine deformity experts was conducted which showed adequate intra and inter-rater reliability with a Fleiss kappa coefficient reaching a value of 0.9 for main curve types and 0.75 for subtypes with first modifier [ 5 ]. This finding emphasizes the fact that the main interest of the classification was to individualize patterns of coronal malalignment and verify their understanding and recognition by spinal surgeons, which was demonstrated.…”

Section: Main Textmentioning

confidence: 99%

The Obeid-coronal malalignment classification is reliable and helps guiding decision-making and surgical management of adult spinal deformities: letter to the editor of BMC Musculoskeletal Disorders

Bourghli

¹

,

Boissière²,

Obeid³

2023

BMC Musculoskelet Disord

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A recently published article by Zhang et al. in BMC Musculoskeletal Disorders reported that the classification of coronal deformity based on preoperative global coronal malalignment for adult spinal deformity is questionable. The aim of the paper was to specifically discredit the Obeid-Coronal Malalignment (O-CM) classification. In this correspondence, we thought it judicious to clarify misunderstood concepts by the authors. We highlight several limitations of their study, and explain the deep interest of the classification from our perspective in order to avoid misleading the readers. Overarching, we aim to help the colleagues through a constructive rather than destructive approach to better understand the foundations of a coronal malalignment classification.

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“…Moreover, Hayashi et al . 14 demonstrated that the Obeid‐coronal malalignment classification may allow better surgical decision making for CM.…”

Section: Introductionmentioning

confidence: 99%

“…They described various surgical strategies for those patients with different coronal spine alignments in detail. Moreover, Hayashi et al 14 demonstrated that the Obeidcoronal malalignment classification may allow better surgical decision making for CM. However, there were few studies focusing on investigating the characteristics of coronal spinal alignment preoperatively, which may be essential for the coronal realignment in correction surgery.…”

Section: Introductionmentioning

confidence: 99%

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Factors Related to Preoperative Coronal Malalignment in Degenerative Lumbar Scoliosis: An Analysis on Coronal Parameters

Zhang

¹

,

Liu

²

,

Wang

³

et al. 2022

Orthopaedic Surgery

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Objectives Recently the effects of coronal malalignment (CM) in degenerative lumbar scoliosis (DLS) have been reported, however, there was few studies on the correlated parameters of coronal alignments at pre‐operation. The aims of this current study were to investigate the associations of coronal parameters with scoliosis and coronal alignment, and to explore the relationships between the coronal pelvic tilt and coronal alignment in DLS. Methods One hundred and sixty‐one DLS patients in our hospital from May 2016 to December 2020 were reviewed and documented. The coronal balance distance (CBD, the offset between the center of C7 and the plumb line drawn from the center of S1), major Cobb (MC), fractional Cobb (FC), L4 coronal tilt, L5 coronal tilt, coronal pelvic tilt, apical rotation, and the vertebras in major curve were measured and documented. CM was considered if the CBD ≥ 30mm. All of those participants were assigned into group A (CBD ≥ 30 mm) and group B (CBD < 30 mm). Comparisons of demographic and radiographic data were performed between groups A and B. Pearson correlation and further multiple regression with stepwise method analysis were used to investigate those coronal parameters correlated to MC and CBD, respectively. Results Thirty‐one patients suffering from CM were assigned into group A, and the rest of 130 patients were assigned to group B accordingly. Then the incidence of CM was about 19.3% (31/161). Patients in group A had less vertebras in the main curve ( P = 0.009), however, the apical rotation ( P < 0.001) and the L4 coronal tilt ( P = 0.007) were much larger. Although the MC ( P = 0.426) and FC ( P = 0.06) had no difference between the two groups, the match between MC and FC was much smaller ( p = 0.021) in group A. The coronal pelvic tilt correlated significantly with FC ( r = 0.552, p < 0.001), but mildly with MC ( r = −0.366, p < 0.001), L4 coronal tilt ( r = 0.348, p < 0.001), and L5 coronal tilt ( r = 0.351, p < 0.001), respectively. The CBD correlated strongly with L4 coronal tilt ( r = −0.471, p < 0.001) and L5 coronal tilt ( r = −0.468, p < 0.001), respectively, but mildly with FC ( r = −0.255, p = 0.016). Further multiple regression analysis revealed that only L4 coronal tilt was the independent factor for MC ( r 2 = 0.549, p < 0.001) and CBD ( r 2 ...

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A new classification for coronal malalignment in adult spinal deformity: a validation and the role of lateral bending radiographs

Cited by 9 publications

References 25 publications

Practical Methods of Assessing Coronal Alignment and Outcomes in Adult Spinal Deformity Surgery

Practical Methods of Assessing Coronal Alignment and Outcomes in Adult Spinal Deformity Surgery

The Obeid-coronal malalignment classification is reliable and helps guiding decision-making and surgical management of adult spinal deformities: letter to the editor of BMC Musculoskeletal Disorders

Factors Related to Preoperative Coronal Malalignment in Degenerative Lumbar Scoliosis: An Analysis on Coronal Parameters

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