Classification of normal sagittal spine alignment: refounding the Roussouly classification

Laouissat, Féthi; Sebaaly, Amer; Gehrchen, Martin; Roussouly, Pierre

doi:10.1007/s00586-017-5111-x

Cited by 200 publications

(199 citation statements)

References 24 publications

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“…This classification has been recently updated to include a fifth type, the anteverted type 3 ( Fig. 1) [10]. Moreover, a new classification describing the evolution of the asymptomatic typology under degenerative conditions has been recently proposed by Roussouly [11] (Fig.…”

Section: Introductionmentioning

confidence: 99%

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

et al. 2019

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Purpose To evaluate the incidence of mechanical complications in patients with adult spine deformity (ASD) treated by restoring the normal shape according to the Roussouly classification. Methods This is a retrospective multicentric study with a minimum follow-up of 2 years. Patients operated on with fusion for ASD (minimum performed fusion: L2 to sacrum) were included. Patients with a history of previous spinal fusion of more than three levels were excluded. Spinal and pelvic parameters were measured on the preoperative and the immediate postoperative follow-up. All mechanical complications were recorded. Results A total of 290 patients met the criteria of inclusion with a minimum follow-up of 2 years. Mechanical complications occurred in 30.4% of the cohort. The most common complication was PJK with an incidence of 18% while nonunion or instrumentation failure (rod breakage, implant failure) occurred in 12.4%. 66% of the patients were restored to the normal shape according to the Roussouly classification based on their PI and had a mechanical complication rate of 22.5%, whereas the remaining 34% of patients had a complication rate of 46.8% (p < 0.001). The relative risk for developing a mechanical complication if the algorithm was not met was 3 (CI 1.5-4.3; p < 0.001) Conclusion In the recent literature, there are no clear guidelines for ASD correction. Restoring the sagittal spinal contour to the normal shapes of Roussouly according to the PI could serve as a guideline for ASD treatment. Ignoring this algorithm has a threefold risk of increased mechanical complications. We recommend this algorithm for treatment of ASD. Level of evidence IV cross-sectional observational study. Graphic abstractThese slides can be retrieved under Electronic Supplementary Material. Sebaaly AY, Gehrchen M, Silvestre C, Kharrat KE, Bari TJ, Kreichati G, Rizkallah M, Roussouly P (2019) Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study. Eur Spine J;

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Section: Introductionmentioning

confidence: 99%

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

et al. 2019

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“…2). Assessment of pelvic incidence (PI), pelvic tilt (PT), SS, and Roussouly's classification according to SS were performed [11,12].…”

Section: Analysis Of X-rays and Lumbo-pelvic Parametersmentioning

confidence: 99%

“…Use of Roussouly's classification for the sagittal morphotype did not consider in the type 3 subgroup of patient with anteverted pelvis as described in the recent classification [11], which can partly explain the variations between pre-and postoperative assessments. However our study focused on the specific analysis of the modifications of the segmental LL particularly in unbalanced patient or patients balanced with abnormal kinematics parameters, and significant variations of the distal arch of the LL mainly in the unbalanced population were observed.…”

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confidence: 99%

Prospective Evaluation of Spino-Pelvic Parameters with Clinical Correlation in Patients Operated with an Anterior Lumbar Interbody Fusion

et al. 2020

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The goal of this study was to evaluate the impact of anterior lumbar interbody fusion (ALIF) on L5-S1 level for restitution of distal segmental lordosis and to investigate its consequences on spino-pelvic parameters and the global sagittal balance. Overview of Literature: Lumbar surgery must be adapted to the spinal morphology in order to restore an adequate relation between pelvic and spinal parameters and especially to the pelvic incidence. Methods: An observational, prospective study was conducted between January 2013 and May 2017. Eighty-six patients were treated by L5-S1 ALIF procedure regardless of disc replacement above L5-S1 level. Thirty-seven patients were included and subset analyses were performed on 25 patients operated on an isolated ALIF L5-S1 (group 1), and 12 patients with hybrid surgery consisting of an L5-S1 ALIF procedure and a L4-L5 lumbar disc replacement (group 2). Clinical parameters were analyzed using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at M0 (preoperative) and M12 (12 months). Lumbo-pelvic parameters were assessed on a standing full-spine X-ray, preoperatively and at M12 after surgery. Results: We observed a significant evolution of L1-S1 lumbar lordosis (p<0.001) with a significant increase of the distal arch L4-S1 lordosis (p<0.001) and decrease of the proximal arch lordosis (p=0.03). Preoperatively, 27% of the patients were unbalanced. Significant variation in sagittal balance parameters was observed, with a decrease of the sagittal vertebral axis (p<0.001). VAS and ODI improved significantly but no correlation was found. An evolution in the same direction was found in the two subgroup analyses. Conclusions: ALIF procedure on L5-S1 level allowed a reconstruction of lumbosacral segmental lordosis, modification of global lordosis, without variation of spino-pelvic parameters except an improvement in sagittal balance.

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“…Sagittal spinal alignment and lumbar lordosis shape varies across individuals [1][2][3][4][5] . It has been a research hot spot nowadays, since Roussouly classi cation of normal spinal sagittal pro le [6][7][8] . Roussouly and colleagues established the classi cation consisting of 5 types according to pelvic incidence (PI) value 8 .…”

Section: Introductionmentioning

confidence: 99%

“…It has been a research hot spot nowadays, since Roussouly classi cation of normal spinal sagittal pro le [6][7][8] . Roussouly and colleagues established the classi cation consisting of 5 types according to pelvic incidence (PI) value 8 . Lumbar lordosis (LL) morphology differs among the 5 types, including LL apex, in exion point, LL value, and lordosis distribution index (LDI), which means the proportion of distal lumbar lordosis (DLL) in global lordosis 8 .…”

Section: Introductionmentioning

confidence: 99%

Lumbar Lordosis Morphology Correlates to Erector Spinae Muscularity in Asymptomatic Asian Adults

Wang

Sun

2020

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Background It is still blank on the relationship between lumbar lordosis morphology and paraspinal muscle in asymptomatic Asian adults. The study aims to investigate the relationships. Methods 87 asymptomatic adults aged between 18 and 45 years old were enrolled in the retrospective study. Lumbar lordosis morphology, consisting of total lumbar lordosis (LL), proximal lumbar lordosis (PLL), distal lumbar lordosis (DLL), lumbar lordosis apex (LLA) and inflexion point (IP), was evaluated, as well as pelvic incidence (PI) and muscularity of erector spinae (ES) and multifidus (MF). Pearson correlation was performed to analyze the relationship between each other parameter. Cases were stratified according to pelvic incidence (very low < 30°, low 30°-45°, moderate 45°-60°, and high > 60°), comparison between groups was performed by univariance analysis. Results PLL revealed a correlation with LLA (r = 0.603, p = 0.002) and inflexion point (r = 0.536, p = 0.004), but did not DLL with LL apex (r = 0.204, p = 0.058) or inflexion point (r = 0.210, p = 0.051). PI revealed a greater correlation with PLL (r=-0.673, p < 0.001) than with DLL (r=-0.237, p = 0.045). Linear stepwise regression analysis also exhibited the correlation between PI and PLL (R2 = 0.452, PLL = 16.2–0.61*PI, p < 0.001). ES muscularity correlated with LL apex (r=-0.279, p = 0.014) and inflexion point (r=-0.227, p = 0.047). Stratification by PI demonstrated PLL increased across groups (p < 0.001), but DLL was comparable between low and moderate PI group (p = 0.329). Conclusion Lumbar lordosis morphology correlates to erector spinae muscularity. Proximal lumbar lordosis has a bigger correlation with pelvic incidence than the distal lumbar lordosis. The results are helpful for restoring a rational lumbar lordosis shape in long fusion surgery.

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Classification of normal sagittal spine alignment: refounding the Roussouly classification

Cited by 200 publications

References 24 publications

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

Prospective Evaluation of Spino-Pelvic Parameters with Clinical Correlation in Patients Operated with an Anterior Lumbar Interbody Fusion

Lumbar Lordosis Morphology Correlates to Erector Spinae Muscularity in Asymptomatic Asian Adults

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