Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain

Lazennec, Jean-Yves; Ramaré, S.; Arafati, N.; Laudet, C. G.; Gorin, Michael A.; Röger, B.; Hansén, Sven‐Erik; Saillant, G; Maurs, L; Trabelsi, R.

doi:10.1007/s005860050008

Cited by 412 publications

(288 citation statements)

References 26 publications

Supporting

Mentioning

258

Contrasting

Unclassified

Order By: Relevance

“…Several studies have analyzed spino-pelvic alignment in the general population [3,7], aging populations [5,8], and patients with lumbar degenerative disease [9][10][11]. It is well known that patients with LDH sometimes present with a forward-bending posture while walking.…”

Section: Discussionmentioning

confidence: 99%

Sagittal spinal alignment in patients with lumbar disc herniation

et al. 2009

View full text Add to dashboard Cite

A retrospective cross-sectional study was designed to evaluate total sagittal spinal alignment in patients with lumbar disc herniation (LDH) and healthy subjects. Abnormal sagittal spinal alignment could cause persistent low back pain in lumbar disease. Previous studies analyzed sciatic scoliotic list in patients with lumbar disc herniation; but there is little or no information on the relationship between sagittal alignment and subjective findings. The study subjects were 61 LDH patients and 60 age-matched healthy subjects. Preoperative and 6-month postoperatively lateral whole-spine standing radiographs were assessed for the distance between C7 plumb line and posterior superior corner on the top margin of S1 sagittal vertical axis (SVA), lumbar lordotic angle between the top margin of the first lumbar vertebra and first sacral vertebra (L1S1), pelvic tilting angle (PA), and pelvic morphologic angle (PRS1). Subjective symptoms were evaluated by the Japanese Orthopedic Association (JOA) score for lower back pain (nine points). The mean SVA value of the LDH group (32.7 ± 46.5 mm, ± SD) was significantly larger than that of the control (2.5 ± 17.1 mm), while L1S1 was smaller (36.7 ± 14.5°) and PA was larger (25.1 ± 9.0°) in LDH than control group (49.0 ± 10.0°and 18.2 ± 6.0°, respectively). At 6 months after surgery, the malalignment recovered to almost the same level as the control group. SVA correlated with the subjective symptoms measured by the JOA score. Sagittal spinal alignment in LDH exhibits more anterior translation of the C7 plumb line, less lumbar lordosis, and a more vertical sacrum. Measurements of these spinal parameters allowed assessment of the pathophysiology of LDH.

show abstract

Section: Discussionmentioning

confidence: 99%

Sagittal spinal alignment in patients with lumbar disc herniation

et al. 2009

View full text Add to dashboard Cite

show abstract

“…There are very few studies on the role of alteration of sagittal plane anatomy in contributing to ASD [19,27]. Lazennec et al [18] showed a statistically significant correlation between reduction of sacral inclination and back pain following lumbosacral fusion.…”

Section: Discussionmentioning

confidence: 99%

“…

…”

mentioning

confidence: 99%

Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion

Kumar¹,

2001

View full text Add to dashboard Cite

IntroductionAdjacent segment degeneration (ASD) has been reported by many authors following lumbar and lumbosacral fusions [1,5,7,9,13,19,21,23,24,26,30,31,32]. In this study the term ASD is used to refer to the onset of degenerative changes in the previously normal disc spaces adjacent to the fusion segment. This becomes symptomatic in many cases and may need re-operation. It is well known that re-operations following lumbar fusions do not always carry good results and that the percentage of good results decreases with each revision surgery [4,11,16]. It is therefore essential to minimize the possibility of re-operation as much as possible. The reasons for adjacent segment degeneration are not fully understood as yet, although various causes have been speculated. The aim of this study is to examine the association of sagittal plane alterations with ASD.Abstract Adjacent segment degeneration following lumbar spine fusion remains a widely acknowledged problem, but there is insufficient knowledge regarding the factors that contribute to its occurrence. The aim of this study is to analyse the relationship between abnormal sagittal plane configuration of the lumbar spine and the development of adjacent segment degeneration. Eightythree consecutive patients who underwent lumbar fusion for degenerative disc disease were reviewed retrospectively. Patients with spondylolytic spondylolisthesis and degenerative scoliosis were not included in this study. Mean follow-up period was 5 years. Results were analysed to determine the association between abnormal sagittal configuration and post operative adjacent segment degeneration. Thirty-one out of 83 patients (36.1%) showed radiographic evidence of adjacent segment degeneration. Patients with normal C7 plumb line and normal sacral inclination in the immediate post operative radiographs had the lowest incidence of adjacent level change compared with patients who had abnormality in one or both of these parameters. The difference was statistically significant (P<0.02). There was no statistically significant difference in the incidence of adjacent level degeneration between male and female patients; between posterior fusion alone and combined posterolateral and posterior interbody fusions; and between fusions extending down to the sacrum and fusions stopping short of the sacrum. It was concluded was that normality of sacral inclination is an important parameter for minimizing the incidence of adjacent level degeneration. Retrolisthesis was the most common type of adjacent segment change. Patients with post operative sagittal plane abnormalities should preferably be followed-up for at least 5 years to detect adjacent level changes.

show abstract

“…Recent studies support the idea that analysis of sagittal balance is a crucial keypoint to optimize the management of lumbar degenerative diseases, especially when spinal instrumentation is intended [7,13,15,16].…”

Section: Introductionmentioning

confidence: 91%

Compensatory mechanisms contributing to keep the sagittal balance of the spine

Barrey

Roussouly

Huec³

et al. 2013

Eur Spine J

365

244

View full text Add to dashboard Cite

Introduction Aging spine is characterized by facet joints arthritis, degenerative disc disease, bone remodeling and atrophy of extensor muscles resulting in a progressive kyphosis of the lumbar spine. Objective The aim of this paper is to describe the different compensatory mechanisms for patients with severe degenerative lumbar spine. Material and methods According to the severity of the imbalance, three stages are observed: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permit to limit the consequences of loss of lumbar lordosis on global sagittal alignment and therefore contribute to keep the sagittal balance of the spine. Results The basic concept is to extend adjacent segments of the kyphotic spine allowing for compensation of the sagittal unbalance but potentially inducing adverse effects.Conclusion Finally, we propose a three-step algorithm to analyze the global balance status and take into consideration the presence of the compensatory mechanisms in the spinal, pelvic and lower limb areas.

show abstract

Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain

Cited by 412 publications

References 26 publications

Sagittal spinal alignment in patients with lumbar disc herniation

Sagittal spinal alignment in patients with lumbar disc herniation

Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion

Compensatory mechanisms contributing to keep the sagittal balance of the spine

Contact Info

Product

Resources

About