Coronal Spinal Balance in Adult Spine Deformity Patients With Long Spinal Fusions

Ploumis, Avraam; Simpson, Andrew K.; Thomas, DK; Herzog, Joshua P.; Wood, Kirkham B.

doi:10.1097/bsd.0b013e3182aab2ff

Cited by 75 publications

(58 citation statements)

References 9 publications

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“…There is a growing body of literature correlating coronal imbalance with a negative effect on patient outcomes. 4 , 11 , 12 , 21 Pluomis et al 12 showed that patients with coronal imbalance, defined as >5 cm in their study, showed a negative correlation with both mental health, vitality and physical function scores. In a large retrospective analysis, Koller et al 11 determined that patients with coronal imbalance at follow-up had poorer clinical outcomes following deformity correction.…”

Section: Discussionmentioning

confidence: 88%

Risk Factors for Postoperative Coronal Balance in Adult Spinal Deformity Surgery

Lewis

Keshen

Kato

et al. 2018

Global Spine Journal

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Study Design:A retrospective case-control study.Objectives:To determine factors influencing the ability to achieve coronal balance following spinal deformity surgery.Methods:Following institutional ethics approval, the radiographs of 47 patients treated for spinal deformity surgery with long fusions to the pelvis, were retrospectively reviewed. The postoperative measurements included coronal balance, L4 tilt, and L5 tilt, levels fused, apical vertebral translation and maximum Cobb angle. L4 and L5 tilt angles were measured between the superior endplate and the horizontal. Sagittal parameters including thoracic kyphosis, lumbar lordosis, pelvic incidence, and sagittal vertical axis were recorded. Coronal balance was defined as the distance between the central sacral line and the mid body of C7 being ≤40 mm. Surgical factors, including levels fused, use of iliac fixation with and without connectors, use of S2A1 screws, interbody devices, and osteotomies. Statistical tests were performed to determine factors that contribute to postoperative coronal imbalance.Results:Of the 47 patients reviewed, 32 were balanced after surgery and 14 were imbalanced. Coronal balance was 1.30 cm from center in the balanced group compared to 4.83 cm in the imbalanced group (P < .01). Both L4 and L5 tilt were statistically different between the groups. Gender and the use of transverse connectors differed between the groups but not statistically.Conclusions:In adult spinal deformity patients undergoing primary fusions to the pelvis, the ability to level the coronal tilt of L4 and L5 had the greatest impact on the ability to achieve coronal balance in this small series. A larger prospective series can help validate this important finding.

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Section: Discussionmentioning

confidence: 88%

Risk Factors for Postoperative Coronal Balance in Adult Spinal Deformity Surgery

Lewis

Keshen

Kato

et al. 2018

Global Spine Journal

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“…Bao et al [3] have found that patients with preoperative convex CM are at higher risk of postoperative persistence or worsening of CM. Ploumis et al [20] in a retrospective analysis of 54 patients followed-up for 2-5 years after long fusions for ASD found that while sagittal malalignment was consistently reduced by surgery, the prevalence of CM did not change from the preoperative to the early postoperative period. In nearly 60% of the cases, preoperative CM was not corrected by surgery, and nearly 9% of patients without preoperative CM showed new onset Postoperative convex coronal malalignment has been described after fusions with the lowest instrumented vertebra (LIV) at L5 for lumbar scoliosis with the use of transpsoas lateral cages, and the likely mechanism is overcorrection of the main lumbar curve over a stiff L5-S1 segment that cannot correct spontaneously to achieve a horizontal takeoff [21].…”

Section: Discussionmentioning

confidence: 98%

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

et al. 2018

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Introduction In adult spinal deformity (ASD), sagittal imbalance and sagittal malalignment have been extensively described in the literature during the past decade, whereas coronal imbalance and coronal malalignment (CM) have been given little attention. CM can cause severe impairment in adult scoliosis and ASD patients, as compensatory mechanisms are limited. The aim of this paper is to develop a comprehensive classification of coronal spinopelvic malalignment and to suggest a treatment algorithm for this condition. Methods This is an expert's opinion consensus based on a retrospective review of CM cases where different patterns of CM were identified, in addition to treatment modifiers. After the identification of the subgroups for each category, surgical planning for each subgroup could be specified. Results Two main CM patterns were defined: concave CM (type 1) and convex CM (type 2), and the following modifiers were identified as potentially influencing the choice of surgical strategy: stiffness of the main coronal curve, coronal mobility of the lumbosacral junction and degeneration of the lumbosacral junction. A surgical algorithm was proposed to deal with each situation combining the different patterns and their modifiers. Conclusion Coronal malalignment is a frequent condition, usually associated to sagittal malalignment, but it is often misunderstood. Its classification should help the spine surgeon to better understand the full spinal alignment of ASD patients. In concave CM, the correction should be obtained at the apex of the main curve. In convex CM, the correction should be obtained at the lumbosacral junction.Graphical abstract These slides can be retrieved under Electronic Supplementary Material.

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“…However, due to the complexity of the structural pathologies of DLS, it might be challenging to achieve satisfactory correction for each DLS patient, resulting in postoperative coronal imbalance. As reported in the literature, the prevalence of postoperative coronal imbalance in adult scoliosis patients ranged from 25.6 to 31.6% 2,3 . In addition, coronal imbalance may also have negative impact on health-related quality of life 2,4 .…”

Section: Level Of Evidencementioning

confidence: 89%

Orientation of L4 coronal tilt relative to C7 plumb line as a predictor for postoperative coronal imbalance in patients with degenerative lumbar scoliosis

Zhang

Wang

Chi

et al. 2020

Sci Rep

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The study design is case–control. To evaluate the impact of preoperative coronal patterns based on the relationship between orientation of L4 coronal tilt and C7 plumb line on immediate postoperative coronal imbalance in degenerative lumbar scoliosis (DLS) patients. Although lumbosacral fractional curve has been long stressed in correction surgery of DLS, there is paucity of literature focusing on preoperative coronal pattern based on the relationship between orientation of L4 coronal tilt and C7 plumb line and its impact on immediate postoperative coronal imbalance in DLS patients. A consecutive series of DLS patients who underwent deformity correction surgery via posterior-only approach were reviewed. According to the relationship between orientation of L4 coronal tilt and C7 plumb line preoperatively, a total of 77 DLS patients who underwent posterior spinal corrective surgery were classified into: 1. Coronal consistency pattern, L4 coronally tilts toward C7 plumb line; 2. Coronal opposition pattern, L4 coronally tilts opposite C7 plumb line. Coronal imbalance was defined as global coronal malalignment (GCM) on either side more than or equal to 20 mm. Whole-spine standing radiographs of both pattern groups were assessed preoperatively and postoperatively. There were 37 patients with coronal consistency pattern and 40 patients with coronal opposition pattern. Compared to patients with coronal opposition pattern, patients with coronal consistency pattern had significantly higher postoperative GCM (P = 0.028), lower amount of GCM correction (P = 0.013) and higher incidence of postoperative coronal imbalance (P = 0.001); further logistic regression analysis revealed coronal consistency pattern was associated with increased odds of postoperative coronal imbalance (odds ratio: 5.981; 95% confidence interval 2.029–17.633; P = 0.001). DLS patients with preoperative coronal consistency pattern carried greater risk for immediate postoperative coronal imbalance following posterior long correction surgery. Level of evidence 3

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Coronal Spinal Balance in Adult Spine Deformity Patients With Long Spinal Fusions

Cited by 75 publications

References 9 publications

Risk Factors for Postoperative Coronal Balance in Adult Spinal Deformity Surgery

Risk Factors for Postoperative Coronal Balance in Adult Spinal Deformity Surgery

Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline

Orientation of L4 coronal tilt relative to C7 plumb line as a predictor for postoperative coronal imbalance in patients with degenerative lumbar scoliosis

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