Dynamic sagittal balance evaluated by 3-dimentional gait analysis in patients with degenerative lumbar kyphosis

Shiba, Yo; Taneichi, Hiroshi; Inami, Satoshi; Moridaira, Hiroshi; Takeuchi, Daisaku; Ohe, Makoto; Nohara, Yutaka

doi:10.1186/1748-7161-10-s1-p11

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“…It is defined as sagittal imbalance caused by lumbar kyphosis or loss of lumbar lordosis (LL) [ 3 ]. Dynamic imbalance and obvious stooping are the characteristics of LDK [ 4 , 5 ]. Takemitsu et al [ 6 ] revealed the pathology as disc narrowing and lumbar extensor muscle atrophy.…”

Section: Introductionmentioning

confidence: 99%

Erector Spinae Atrophy Correlates with Global Sagittal Imbalance and Postoperative Proximal Junctional Kyphosis Incidence in Lumbar Degenerative Kyphosis

Wang,

Li,

Zhang

et al. 2024

Asian Spine J

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Study Design: Retrospective cohort study.Purpose: This study aimed to investigate the relationship between lumbar erector muscle atrophy and global sagittal imbalance in lumbar degenerative kyphosis (LDK) and with postoperative proximal junctional kyphosis.Overview of Literature: Lumbar erector muscle atrophy has been studied in LDK. However, its role in the compensatory mechanism is still under intense discussion, and the role of erector spinae (ES) muscle is always overlooked.Methods: This study enrolled 51 patients with LDK out of 382 patients with adult degenerative spinal deformity. Baseline information was reviewed including demographic data and complications. Sagittal spinopelvic alignments and global imbalance parameters were assessed on full-length X-ray images of the spine. Muscularity and the fatty infiltration area of the ES and multifidus (MF) were measured at the L4/5 level on preoperative magnetic resonance image to evaluate the lumbar erector muscle atrophy. Stratification by sagittal vertical axis (SVA) was performed: group 1 with SVA <100 mm and group 2 with SVA >100 mm, and these groups were compared. Spearman correlation and multivariable logistic regression analyses were performed to analyze and define risk factors of postoperative proximal junctional kyphosis (PJK).Results: Group 2 had lower ES and MF muscularity than group 1. ES muscularity correlated with SVA (r=−0.510, p<0.003), lumbar lordosis (r=−0.415, p<0.018), and postoperative PJK (r=−0.508, p<0.022). MF muscularity did not correlate with the above parameters. Multivariable logistic regression analysis verified ES muscularity (odds ratio [OR], 0.001; p<0.039) and SVA (OR, 1.034; p<0.048) as the risk factors for postoperative PJK.Conclusions: ES atrophy, besides the MF, is an important predictor in distinguishing decompensated LDK from well-compensated ones. It plays an important role in compensatory mechanism, not only correlates with global sagittal imbalance but also ties to PJK after deformity corrective surgery.

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