Sagittal Rebalancing of the Pelvis and the Thoracic Spine After Pedicle Subtraction Osteotomy at the Lumbar Level

Rousseau, Marc-Antoine; Lazennec, Jean-Yves; Tassin, Jean-Louis; Fort, D.

doi:10.1097/bsd.0b013e318272faaf

Cited by 12 publications

(9 citation statements)

References 4 publications

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“…In general, Correlation between spinal parameter and pelvic parameter is important for spinal sagittal balance 11) . The most important correlation is between the PI as anatomical index and the SS as the positional index 7 , 15) .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Global Sagittal Balance in Koreans Adults

Cho

2017

J Korean Neurosurg Soc

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ObjectvieThe global sagittal postural patterns as characterized by Roussouly classification have been previously described in various ethnicities, there were no studies investigated in Koreans. To analyze the distribution of the global sagittal postural patterns in Korean adults using Roussouly classification, the author prospectively studied.Methods252 asymptomatic Korean adults was recruited. Data was obtained by reviewing the films for each subject. Spinopelvic parameters were measured and sagittal postural patterns were then determined according to Roussouly classification. We compared the data across different ethnicities from our study and a previous study to further characterize Korean sagittal postures.ResultsThe subject included 151 males and 101 females, with mean age of 33.2±8.2 years. The average descriptive results were as below: thoracic kyphosis 28.6±7.7°, lumbar lordosis 48.3±10.2°, sacral slope 37.8±5.8°, pelvic incidence 45.1±7.5°, pelvic tilt 9.4±6.7°, spinosacral angle 130.1±5.4°, and sagittal vertical axis 16.25±22.5 mm. 125 subjects among 252 (49.6%) belonged to Roussouly type 3 (namely neutral). There were also 58 (23%), 33 (13.1%), and 36 (14.3) subjects in type 1, 2, and 4 (namely non-neutral), respectively.ConclusionEnrolling 252 asymptomatic Korean adults, this prospective study found that 49.6% of asymptomatic Korean adults possessed a sagittal posture of Roussouly type 3. All radiologic parameters follows general concept of spinal sagittal balance pattern. Overall, this study might be a basis for further investigation of spinal sagittal balance.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Global Sagittal Balance in Koreans Adults

Cho

2017

J Korean Neurosurg Soc

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“…Previous studies have demonstrated varying proportions of trunk versus pelvic correction based on the spinal pathology and ankylosis. 27,36 While there were correlations between LL correction outside the 3CO and correction of sagittal parameters, this study found no correlation between 3CO and change in radiographic parameters. This could indicate that the 3CO is not the only factor in correction surgery that leads to global realignment.…”

Section: Figmentioning

confidence: 52%

“…This result echoes the findings of Rousseau et al, who studied 356 patients undergoing 3CO for the treatment of ASD. 35,36 Their results demonstrated no significant impact of pedicle subtraction osteotomy level on postoperative PT or T1SPi. One specific finding of the current study relates to the correlation between change in PT and location of the postoperative apex of the lumbar curve (R = -0.175, p < 0.05).…”

Section: Figmentioning

confidence: 91%

“…13,15 However, more recent work demonstrated that the degree of wedge resection correlated more closely with spinopelvic parameter correction than 3CO level. 24,36 The authors also established that there was no correlation between 3CO level and SVA correction. 23 The present study similarly demonstrated that there were no correlations between 3CO level and changes in spinopelvic or global sagittal parameters.…”

Section: Figmentioning

confidence: 97%

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Sagittal alignment and complications following lumbar 3-column osteotomy: does the level of resection matter?

Ferrero

Liabaud

Henry

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEThree-column osteotomy (3CO) is a demanding technique that is performed to correct sagittal spinal malalignment. However, the impact of the 3CO level on pelvic or truncal sagittal correction remains unclear. In this study, the authors assessed the impact of 3CO level and postoperative apex of lumbar lordosis on sagittal alignment correction, complications, and revisions.METHODSIn this retrospective study of a multicenter spinal deformity database, radiographic data were analyzed at baseline and at 1- and 2-year follow-up to quantify spinopelvic alignment, apex of lordosis, and resection angle. The impact of 3CO level and apex level of lumbar lordosis on the sagittal correction was assessed. Logistic regression analyses were performed, controlling for cofounders, to investigate the effects of 3CO level and apex level on intraoperative and postoperative complications as well as on the need for subsequent revision surgery.RESULTSA total of 468 patients were included (mean age 60.8 years, mean body mass index 28.1 kg/m2); 70% of patients were female. The average 3CO resection angle was 25.1° and did not significantly differ with regard to 3CO level. There were no significant correlations between the 3CO level and amount of sagittal vertical axis or pelvic tilt correction. The postoperative apex level significantly correlated with greater correction of pelvic tilt (2° per more caudal level, R = −0.2, p = 0.006). Lower-level 3CO significantly correlated with revisions for pseudarthrosis (OR = 3.88, p = 0.001) and postoperative motor deficits (OR = 2.02, p = 0.026).CONCLUSIONSIn this study, a more caudal lumbar 3CO level did not lead to greater sagittal vertical axis correction. The postoperative apex of lumbar lordosis significantly impacted pelvic tilt. 3CO levels that were more caudal were associated with more postoperative motor deficits and revisions.

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“…Chen et al [22] asserted that structural damage to the hips can contribute to mobility limitation, functional impairment, and the inability to exercise. Rousseau et al [23] studied the spinal balance of 356 patients and determined that spondylarthritis cases showed less pelvic reorientation after lumbar PSO, probably due to limitations in hip mobility.…”

Section: Discussionmentioning

confidence: 99%

Hip involvement negatively impact the postoperative radiographic outcomes after lumbar pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis-a retrospective study

Qian

Zhang³

et al. 2019

CSRC

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Background: Lumbar pedicle subtraction osteotomy (PSO) can significantly correct thoracolumbar kyphosis and relieve compensatory backward pelvic tilt (PT). However, hip involvement for some advanced ankylosing spondylitis (AS) patients can restrict the rotation of the pelvis around the femoral heads, which may affect the postoperative radiographic outcomes after lumbar PSO. Objective: To identify whether hip involvement negatively impacts the postoperative radiographic outcomes after lumbar PSO in AS patients with thoracolumbar kyphosis. Methods: Between March 2009 and June 2013, a total of 44 consecutive AS patients with thoracolumbar kyphosis who had undergone one-level lumbar PSO were retrospectively reviewed. All the patients had more than two years of follow-up. Hip involvement was evaluated based on the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-hip) and defined by a score of at least 2. All patients were divided into group A (patients without hip involvement) and group B (patients with hip involvement). Radiographical measurements included sagittal vertical axis (SVA), global kyphosis (GK), thoracic kyphosis (TK), local kyphosis (LK), lumbar lordosis (LL), pelvic incidence (PI), PT, and sacral slope (SS). The visual analogue pain scale for low back pain was also recorded. Results: Preoperative SVA and PT were not significantly different between group A and group B (SVA: 14.0 ± 6.3 cm vs. 14.7 ± 6.0 cm, P > 0.05; PT: 36.8° ± 7.1° vs. 37.3° ± 7.7°, P > 0.05), and both groups had similar magnitudes of kyphosis corrections (LK correction: 44.9° ± 4.9° vs. 44.2° ± 8.3°, P > 0.05). However, group B had significantly larger SVA and PT than group A (SVA: 7.6 ± 4.5 cm vs 3.5 ± 3.4 cm, P < 0.05; PT: 28.1° ± 8.6° vs. 19.0° ± 8.0°, P < 0.05) at the last follow-up. Conclusion: In AS patients with thoracolumbar kyphosis, hip involvement led to insufficient correction of SVA and PT after lumbar PSO, which negatively impacted postoperative radiographic outcomes. For these patients, additional osteotomies are recommended for satisfactory correction outcomes.

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Sagittal Rebalancing of the Pelvis and the Thoracic Spine After Pedicle Subtraction Osteotomy at the Lumbar Level

Abstract: Level II.

Cited by 12 publications

References 4 publications

Evaluation of Global Sagittal Balance in Koreans Adults

Evaluation of Global Sagittal Balance in Koreans Adults

Sagittal alignment and complications following lumbar 3-column osteotomy: does the level of resection matter?

Hip involvement negatively impact the postoperative radiographic outcomes after lumbar pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphosis-a retrospective study

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