Sagittal Alignment of the Lumbar Spine

Berven, Sigurd; Wadhwa, Rishi

doi:10.1016/j.nec.2018.03.009

Cited by 43 publications

(31 citation statements)

References 21 publications

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“…Sagittal alignment of the lumbar spine has an important and measurable impact on the pathogenesis of lumbar spine disorder and contributions to ASD [16]. Anatomic pelvic parameters also have an association with lumbar spinal degeneration, such as lumbar spinal stenosis and degenerative spondylolisthesis [17].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for upper adjacent segment degeneration after multi-level posterior lumbar spinal fusion surgery

Huang

Sun

et al. 2019

J Orthop Surg Res

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Background Posterior lumbar spinal fusion has been widely used in degenerative lumbar stenosis, but adjacent segment degeneration (ASD) was common. Researchers have found many risk factors for ASD after one or two levels of surgery, but few clinical studies focused on multi-level surgery. The purpose of this study was to clarify risk factors for upper ASD after multi-level posterior lumbar spinal fusion. Methods A retrospective study was performed on the clinical data of 71 patients with degenerative lumbar stenosis who underwent multi-level (at least 3 levels) posterior lumbar spinal fusion from January 2013 to December 2016. Two groups were divided according to lamina and posterior ligamentous complex (PLC) maintenance of proximal fixed vertebrae in surgery. In the 22 patients of group A, the proximal fixed vertebral lamina and PLC were not resected, and in the 49 patients of group B, the proximal fixed vertebral lamina and PLC were resected completely. Age, sex, body mass index (BMI), number of fixed vertebrae and fused levels, spinopelvic parameters, coronal Cobb angle, and modified Pfirrmann grading system were measured for each patient. A Cox proportional hazards model was used to analyze risk factors for upper ASD. Results No symptomatic ASD was found during the follow-up period. Patients who underwent proximal fixed vertebral lamina and PLC resection had a significantly higher percentage of radiographic ASD ( P = 0.042). The Cox proportional hazards model showed that age, sex, BMI, preoperative lumbar lordosis, sacral slope, pelvic tilt, coronal Cobb angle, number of fixed vertebrae, and interbody fusion levels had no significant differences for radiographic ASD. But a preoperative modified Pfirrmann grade higher than 3, a high degree of preoperative pelvic incidence, and more decompressed levels had statistical significance ( P = 0.024, 0.041, and 0.008, respectively). Conclusions A preoperative modified Pfirrmann grade higher than 3, a high degree of preoperative pelvic incidence, and more decompressed levels might be risk factors for upper radiographic ASD after multi-level posterior lumbar spinal fusion surgery.

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Section: Discussionmentioning

confidence: 99%

Risk factors for upper adjacent segment degeneration after multi-level posterior lumbar spinal fusion surgery

Huang

Sun

et al. 2019

J Orthop Surg Res

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“…According to the theory of Barrey et al, the majority of DTLK patients were in a state of compensate balance. Although some cases were in imbalance after the surgery, the tension of paraspinal muscle was relaxed and with no difference in QOL compared to ones with equilibrium state [8,28].…”

Section: Discussionmentioning

confidence: 93%

Spino-pelvic sagittal parameters in patients with degenerative thoracolumbar kyphosis combined with lumbar stenosis syndrome

Xu¹,

Guo²,

Yan³

et al. 2020

Preprint

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Objective The patients diagnozed degenerative thoracolumbar kyphosis (DTLK) with lumbar spinal syndrome (LSS) were enrolled, to identify the significance of spino-pelvic parameters in this group.Methods An overall 138 (M/F=53/85) patients were enrolled with a mean follow-up of 24.6±11.1 (m). All cases were performed short-segment posterior fusion on LSS region. Radiological parameters were TLK, LL, PI, PT and SVA obtained on the X-ray. Quality of life (QOL) were evaluated by the visual analogue scale (VAS) and the Oswestry disability index (ODI). Accorrding to age-related formula by Lafage, various thresholds on PI-LL, PT and SVA were determined, ensuing three pairs of normal and abnormal groups were respectively divided into based on these parameters. Results Both VAS and ODI statistically improved (P <0.001). At the endpoint, TLK decreased by a mean of 8.2±8.8° and cases got TLK-correction occupied 40.4%. The whole balance status (normal SVA) was improved compared to baseline (P=0.006), so was the ratio of matched PI-LL (P=0.002), but the ratio of normal PT and larger PT was of no significance (P=0.794). The final balance status was irrelevant to QOL whatever balance status at baseline. However, ODI in PI-LL matched group or in normal PT group were respectively less than that of abnormal groups (P=0.022 and P=0.019).Conclusions The mean TLK decreased even a short-segment fusion purely performed on LSS. QOL was related to PI-LL and PT, but not to SVA in DTLK patients.

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“…The study rstly clari ed the characteristics of BMI and paraspinal muscle distribution in DTLK patients by a case-control study. It emphasizd that paraspinal muscle need be paid attention to for DTLK and function excizising or rehabilitation training on paraspinal muscle after surgery was neceseery for promoting the reconstruction of sagittal spinal sequence [28]. Then, the introduction of the LCIV simpli ed the measurement procedure of paraspinal muscle, saving time and cost for outpatient doctor to make a preliminary judgment and for the patient to perform a self-check [12,29].…”

Section: Discussionmentioning

confidence: 99%

Lumbar Posterior Muscle and Local Kyphosis in Patients with Degenerative Thoracolumbar Kyphosis: A Case-Control Study

Guo

Yan

et al. 2020

Preprint

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Purpose: To explore the relationship between thoracolumbar kyphosis (TLK), body mass index (BMI) and the content of lumbar posterior muscles in patients with degenerative thoracolumbar kyphosis (DTLK) combined with lumbar stenosis syndrome (LSS).Methods: 126 patients with DTLK and LSS (DTLK group) and 87 patients with simple LSS (control group) were retrospectively included with well-matched demographics. TLK and lumbar lordosis (LL) were obtained on the X-ray of the whole spine. Lumbar crossing indentation value (LCIV) was introduced to evaluate the content of the lumbar muscles, with was measured from T12-L1 to L4-L5 at T2-MRI axial imaging. Three subgroups of normal weight, overweight and obesity were respectively divided into in both groups according to BMI. Three subgroups of increased LL, normal LL normal and decreased LL were also divided into in DTLK group.Results: The mean LCIV (mLCIV) of the DTLK group was less than control group and LCIV showed an increasing trend in DTLK group from T12-L1 to L4-L5. Different from control group, there were no significances in gender and BMI distribution of mLCIV in DTLK group (P>0.05). LCIV in increased LL subgroup was larger than that of normal LL and less LL subgroup (P<0.01). There were no relationship between TLK and BMI in both groups. BMI was positively correlated with mLCIV in control group(P=0.004). TLK and LCIV were negatively correlated (P<0.001) in DTLK group with LCIV=13.75-0.48×TLK.Conclusion: LCIV in DTLK group was less than control group with no gender- and BMI-difference. LCIV and TLK were mutually predictable in DTLK with LCIV=13.75-0.48×TLK.

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Sagittal Alignment of the Lumbar Spine

Cited by 43 publications

References 21 publications

Risk factors for upper adjacent segment degeneration after multi-level posterior lumbar spinal fusion surgery

Risk factors for upper adjacent segment degeneration after multi-level posterior lumbar spinal fusion surgery

Spino-pelvic sagittal parameters in patients with degenerative thoracolumbar kyphosis combined with lumbar stenosis syndrome

Lumbar Posterior Muscle and Local Kyphosis in Patients with Degenerative Thoracolumbar Kyphosis: A Case-Control Study

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