Abstract:The major focus of realignment in adult spinal deformity (ASD) surgery has been on the sagittal plane, and less emphasis has been given to the coronal plane. In light of this overlooked area within ASD surgery, we aimed to refocus the narrative on coronal alignment in ASD surgery. The objectives of the current narrative review were to (1) define coronal alignment and discuss existing measurements; (2) report the incidence and prevalence of coronal malalignment (CM); (3) discuss the impact of CM on clinical out… Show more
“…2 ), including: (1) segmental wedging angle (SWA), the angle between the inferior endplate of L4 and the superior endplate of L5; (2) lateral vertebral translation (LVT), the distance between two extended lines of the lateral aspect of L4 and L5; and (3) coronal vertical axis (CVA), the distance between the center of S1 and the vertical line from the C7 body center. Local coronal imbalance (LCI) was defined as SWA > 5° or LVT > 5 mm, [ 14 , 18 ] and global coronal imbalance (GCI) was defined as LCI combined with CVA > 30 mm [ 19 ]. Fig.…”
Objective
The aim of this study was to investigate the association between spinal alignment and preoperative patient-reported outcomes (PROs) in patients with degenerative lumbar spondylolisthesis (DLS) and to identify the independent risk factors for worse preoperative PROs.
Methods
In total, 101 patients suffering from DLS were retrospectively studied within a single medical center. Age, sex, height, weight, and body mass index were uniformly recorded. PRO-related indicators include the Oswestry Disability Index (ODI), the Japanese Orthopedic Association’s (JOA) score, and the visual analog scale (VAS) for back and leg pain. Sagittal alignment, coronal balance, and stability of the L4/5 level were evaluated through whole-spine anteroposterior and lateral radiographs and dynamic lumbar X-ray.
Results
Increasing age (P = 0.005), higher sagittal vertical axis (SVA) (P < 0.001), and global coronal imbalance (GCI) (P = 0.023) were independent risk factors for higher ODI. Patients with GCI had lower JOA scores (P = 0.001) than those with balanced coronal alignment. Unstable spondylolisthesis (P < 0.001) and GCI (P = 0.009) were two vital predictors of VAS-back pain. Increasing age (P = 0.031), local coronal imbalance (LCI) (P < 0.001), and GCI (P < 0.001) were associated with higher VAS-leg pain. Moreover, patients with coronal imbalance also exhibited significant sagittal malalignment based on the subgroup analysis.
Conclusion
DLS patients with higher SVA, unstable spondylolistheses, a combination of LCI/GCI, or increasing age were predisposed to have more severe subjective symptoms before surgery.
“…2 ), including: (1) segmental wedging angle (SWA), the angle between the inferior endplate of L4 and the superior endplate of L5; (2) lateral vertebral translation (LVT), the distance between two extended lines of the lateral aspect of L4 and L5; and (3) coronal vertical axis (CVA), the distance between the center of S1 and the vertical line from the C7 body center. Local coronal imbalance (LCI) was defined as SWA > 5° or LVT > 5 mm, [ 14 , 18 ] and global coronal imbalance (GCI) was defined as LCI combined with CVA > 30 mm [ 19 ]. Fig.…”
Objective
The aim of this study was to investigate the association between spinal alignment and preoperative patient-reported outcomes (PROs) in patients with degenerative lumbar spondylolisthesis (DLS) and to identify the independent risk factors for worse preoperative PROs.
Methods
In total, 101 patients suffering from DLS were retrospectively studied within a single medical center. Age, sex, height, weight, and body mass index were uniformly recorded. PRO-related indicators include the Oswestry Disability Index (ODI), the Japanese Orthopedic Association’s (JOA) score, and the visual analog scale (VAS) for back and leg pain. Sagittal alignment, coronal balance, and stability of the L4/5 level were evaluated through whole-spine anteroposterior and lateral radiographs and dynamic lumbar X-ray.
Results
Increasing age (P = 0.005), higher sagittal vertical axis (SVA) (P < 0.001), and global coronal imbalance (GCI) (P = 0.023) were independent risk factors for higher ODI. Patients with GCI had lower JOA scores (P = 0.001) than those with balanced coronal alignment. Unstable spondylolisthesis (P < 0.001) and GCI (P = 0.009) were two vital predictors of VAS-back pain. Increasing age (P = 0.031), local coronal imbalance (LCI) (P < 0.001), and GCI (P < 0.001) were associated with higher VAS-leg pain. Moreover, patients with coronal imbalance also exhibited significant sagittal malalignment based on the subgroup analysis.
Conclusion
DLS patients with higher SVA, unstable spondylolistheses, a combination of LCI/GCI, or increasing age were predisposed to have more severe subjective symptoms before surgery.
“…Several classification schemes exist to assist surgeons in categorizing and planning coronal correction. 10,11 Although coronal vertical axis (CVA) values of <3 to <4 cm are commonly cited values to define an “acceptable” correction, 11 a neutral CVA is always our goal.…”
Section: Goals Of Minimally Invasive Surgery Deformity Correctionmentioning
Minimally invasive adult spinal deformity (MIS ASD) surgery may offer benefits over conventional techniques in select circumstances. The success of the procedure is based on proper patient selection, restoring adequate alignment, and optimizing fusion. In the past, MIS techniques were limited because of the need to reposition the patient—a source of increased surgical time and potentially patient risk. New developments now allow for single-position, MIS correction of adult deformity. Additional research will be needed to determine the ideal patient for minimally invasive adult spinal deformity surgery and whether prone or lateral single-position confers the best outcomes.
“…Although coronal imbalance is often better tolerated than sagittal imbalance, preoperative coronal malalignment ˃4 cm is associated with increased pain and disability and worse function 1 . Most recently, residual and/or new postoperative coronal malalignment with a magnitude >3 cm has been shown to jeopardize patient outcomes and quality of life scores 3–5 …”
mentioning
confidence: 99%
“…1 Most recently, residual and/or new postoperative coronal malalignment with a magnitude > 3 cm has been shown to jeopardize patient outcomes and quality of life scores. [3][4][5] A subset of deformities are best treated with a pedicle subtraction osteotomy (PSO). These include rigid sagittal and/or coronal deformities that result from severe malalignment (i.e., sagittal imbalance > 10-12 cm; coronal Cobb 70-75 degrees with flexibility <40%), 6,7 short, angular kyphosis 8 with or without a previously fused anterior column.…”
Study Design:
Operative video and supplemental manuscript.
Objective:
To present a novel step-by-step approach to performing a lumbar pedicle subtraction osteotomy (PSO) using laterally based satellite rods.
Summary of Background Data:
Multi-rod constructs have demonstrated paramount for decreasing rates of pseudarthrosis after PSOs. Multi-rods constructs can be achieved using either “satellite” rods (rods not connected to the primary rods) and/or “accessory rods” (rods connected to the primary rods).
Methods:
A step-by-step approach to performing a lumbar PSO using a laterally based satellite rod configuration is provided through a case example and surgical technique video.
Results:
Lateral satellite rods can be particularly useful from a surgical perspective, as they provide temporary stabilization while the PSO is being performed, facilitate closure of the osteotomy site (symmetric and/or asymmetric), and serve as the final fixation rods across the PSO without needing to be exchanged.
Conclusions:
Use of laterally based satellite rods is a useful technique for lumbar PSOs, as they provide temporary stabilization while the PSO is being performed, facilitate closure of the osteotomy site, and serve as the final fixation rods across the PSO without needing to be exchanged.
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