Changes in sagittal alignment after restoration of lower lumbar lordosis in patients with degenerative flat back syndrome

Jang, Jee-Soo; Lee, Sang-Ho; Min, Jun-Hong; Maeng, Dae Hyeon

doi:10.3171/spi-07/10/387

Cited by 85 publications

(34 citation statements)

References 26 publications

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“…The incidence of patients requiring lumbar corrective osteotomy for post-fusion lumbar flatback deformity with sagittal imbalance is increasing as the numbers of spine fusion surgeries and overall average life expectancy increases12). In patients with sagittal imbalance, adequate correction to restore an ideal lumbar lordosis relative to pelvic incidence (PI) in the sagittal plane is very important during corrective osteotomy3). According to Schwab et al15), corrective osteotomy for adult spinal deformity (ASD) leads to good sagittal spinal balance if the range of correction is within lumbar lordosis (LL)=PI±9°, pelvic tilt (PT)<20°, and sagittal vertical axis (SVA)<5 cm.…”

Section: Introductionmentioning

confidence: 99%

Surgical Outcomes of Post-Fusion Lumbar Flatback Deformity with Sagittal Imbalance

Kim

2016

J Korean Neurosurg Soc

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ObjectivesTo review surgical results of post-fusion lumbar flatback treated with pedicle subtraction osteotomy (PSO) or Smith-Petersen osteotomies (SPOs).MethodsTwenty-eight patients underwent osteotomies. Radiological outcomes by sagittal vertical axis (SVA), and pelvic tilt (PT), T1 pelvic angle (T1PA), and pelvic incidence (PI)-lumbar lordosis (LL) at preoperative, postoperative 1 month, and final were evaluated. Oswestry Disability Index (ODI), visual analog scale (VAS) score of back pain/leg pain, and Scoliosis Research Society-22 score (SRS-22r) were analyzed and compared. Patients were divided into 2 groups (SVA ≤5 cm : normal, SVA >5 cm : positive) at final and compared outcomes.ResultsNineteen patients (68%) had PSO and the other 9 patients had SPOs with anterior lumbar interbody fusions (ALIFs) (Mean age : 65 years, follow-up : 31 months). The PT, PI-LL, SVA, T1PA were significantly improved at 1 month and at final (p<0.01). VAS score, ODI, and SRS-22r were also significantly improved at the final (p<0.01). 23 patients were restored with normal SVA and the rest 5 patients demonstrated to positive SVA. SVA and T1PA at 1 month and SVA, PI-LL, and T1PA at final were significantly different (p<0.05) while the ODI, VAS, and SRS-22r did not differ significantly between the groups (p>0.05). Common reoperations were early 4 proximal junctional failures (14%) and late four rod fractures.ConclusionOur results demonstrate that PSO and SPOs with ALIFs at the lower lumbar are significantly improves sagittal balance. For maintenance of normal SVA, PI-LL might be made negative value and T1PA might be less than 11° even though positive SVA group was also significantly improved clinical outcomes.

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Section: Introductionmentioning

confidence: 99%

Surgical Outcomes of Post-Fusion Lumbar Flatback Deformity with Sagittal Imbalance

Kim

2016

J Korean Neurosurg Soc

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“…The small degree of LL, the lumbar angle, and the amplitude of the curvatures, together with the high value of the inclination of the spine, show that the sagittal shape of the spine in these patients is straight with only small curvatures. [8,12–14,16,21,22] In this situation, the compressive force component of gravity increases and then it can accelerate the degeneration of the disc. This increase of the compressive forces may lead to herniation.…”

Section: Discussionmentioning

confidence: 99%

“…Spine surgeons widely received the concept that the sagittal balance as an important factor for managing spinal disease. [7] The importance of pelvic indexes and their relationship (PI = PT+SS) was put forward by Legaye et al [8,9] first. Pelvic incidence (PI) is a fundamental anatomical parameter that is unique for each individual and does not depend on the position or spatial orientation of the pelvis.…”

Section: Methodsmentioning

confidence: 99%

Radiological analysis for thoracolumbar disc herniation in spinopelvic sagittal alignment

Wang

Yang

et al. 2017

Medicine

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A retrospective study aims to explore differences in spinopelvic sagittal alignment between thoracolumbar disc herniation (TLD) and lower lumbar disc herniation (LLD).A total of 185 patients included 26 with TLD and 129 with LLD and 30 asymptomatic volunteers in normal group (NG). Each individual took full spine X-ray to evaluate pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), TK+LL+PI, TK/LL, and sacrum-femoral-pubic symphysis (SFP). The Roussouly classification was used to categorize all subjects according to their sagittal alignment. Spinopelvic parameters and Roussouly classification results were compared between groups.PI (51.0°), SS (30.5°), and LL (42.0°) in the TLD were significantly higher than those in the LLD (47°, 27°, 33°, respectively). However, TK (30.0°), TK/LL (0.75), and TK+LL+PI (40.0°) in the TLD were significantly lower than these in the LLD (33.0°, 1.07, 47.2°, respectively) and the similar trend between TLD and NG (34.3°, 0.93, 48.5°, respectively). But LL (42.0°) in the TLD was significantly higher than in the NG (35°). Roussouly types among 3 groups were marked differences. The LLD had a higher rate (59.7%) of type II lordosis (flat back), and the TLD had a higher rate (61.5%) of type III lordosis than other groups.This study implied that patients with TLD have higher LL, lower TK, TK/LL, and TK+LL+PI than LLD patients. We inferred that high LL combined with low TK may be the prospective factors of TLD.Abbreviations: BMI = body mass index, IQR = interquartile range, LDH = lumbar disc herniation, LL = lumbar lordosis, LLD = lower lumbar disc herniation, NG = normal group, PI = pelvic incidence, PT = pelvic tilt, SFP = sacrum-femoral-pubic symphysis, SS = sacral slope, TK = thoracic kyphosis, TLD = thoracolumbar disc herniation.

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“…Lumbar lordosis plays an important role in the sagittal alignment and balance so that a successful correction of the lumbar lordosis is critical to the functional improvement or patient satisfaction [8]. Although more significant improvement of the dynamic lumbar lordosis was found in the successful group than in the unsuccessful group, no significant difference was found in the static parameters including lumbar lordosis between the two groups.…”

Section: Discussionmentioning

confidence: 99%

“…Decreased lumbar lordosis causes anterior displacement of the center of gravity, which leads to spinopelvic angular changes and further affects standing posture and gait characteristics [56]. The studies regarding spinopelvic imbalance in the patients with DFB have focused mainly on static parameters measured by simple radiography [3789]. However, radiography has the limitation that it can only reveal the static posture, and cannot evaluate the dynamic status, such as ambulation.…”

Section: Introductionmentioning

confidence: 99%

Static and Dynamic Parameters in Patients With Degenerative Flat Back and Change After Corrective Fusion Surgery

Lee

2016

Ann Rehabil Med

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ObjectiveTo evaluate characteristics of static and dynamic parameters in patients with degenerative flat back (DFB) and to compare degree of their improvement between successful and unsuccessful surgical outcome groupsMethodsForty-seven patients with DFB were included who took whole spine X-ray and three-dimensional motion analysis before and 6 months after corrective surgery. Forty-four subjects were selected as a control group. As static parameters, thoracic kyphosis (TK), thoracolumbar junction (TLJ), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured. As dynamic parameters, maximal and minimal angle of pelvic tilt, lower limb joints, and thoracic and lumbar vertebrae column (dynamic TK and LL) in sagittal plane were obtained.ResultsThe DFB group showed smaller TK and larger LL, pelvic posterior tilt, hip flexion, knee flexion, and ankle dorsiflexion than the control group. Most of these parameters were significantly corrected by fusion surgery. Dynamic spinal parameters correlated with static spinal parameters. The successful group obtained significant improvement in maximal and minimal dynamic LL than the unsuccessful group.ConclusionThe DFB group showed characteristic lower limb and spinal angles in dynamic and static parameters. Correlation between static and dynamic parameters was found in spinal segment. Dynamic LL was good predictor of successful surgical outcomes.

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Changes in sagittal alignment after restoration of lower lumbar lordosis in patients with degenerative flat back syndrome

Cited by 85 publications

References 26 publications

Surgical Outcomes of Post-Fusion Lumbar Flatback Deformity with Sagittal Imbalance

Surgical Outcomes of Post-Fusion Lumbar Flatback Deformity with Sagittal Imbalance

Radiological analysis for thoracolumbar disc herniation in spinopelvic sagittal alignment

Static and Dynamic Parameters in Patients With Degenerative Flat Back and Change After Corrective Fusion Surgery

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