Sequential correction technique to avoid postoperative global coronal decompensation in rigid adult spinal deformity: a technical note and preliminary results

Bao, Hongda; Liu, Zhen; Zhang, Yuancheng; Sun, Xu; Jiang, Jun; Qian, Bangping; Mao, Saihu; Qiu, Yong; Zhu, Zezhang

doi:10.1007/s00586-019-06043-9

Cited by 46 publications

(37 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…39 Recent reports have begun to study the role of coronal alignment parameters, as CM has been shown to lead to significant pain, disability, and poor cosmesis. [39][40][41][42][43] CCSM is an even less studied phenomenon in ASD, with a 3 patient case series of such patients describing good correction results, but without much PRO data. 44 With 18% of our cohort classified as CCSM, a sizeable number of ASD patients may fall into this category.…”

Section: Discussionmentioning

confidence: 99%

Do Adult Spinal Deformity Patients Undergoing Surgery Continue to Improve From 1-Year to 2-Years Postoperative?

Zuckerman

Lai

Shen

et al. 2021

Global Spine Journal

View full text Add to dashboard Cite

Objective: Evaluate clinical improvement as measured by patient-reported outcomes (PROs) during the 1 to 2-year interval. Study Design: Retrospective Cohort. Methods: A single-institution registry of ASD patients undergoing surgery was queried for patients with ≥6 level fusions. Demographics and radiographic variables were collected. PROs collected were the ODI and SRS-22r scores at: preoperative, 1-year and 2-years. Outcome measures of clinical improvement during the 1-2 year time interval were: 1) group medians, 2) percent minimum clinically important difference (MCID), and 3) percent minimal symptom scale (MSS)(ODI < 20 or SRS-pain + function >8). Wilcoxon rank-sum tests, chi-squared tests, Kruskal-Wallis tests, and logistic regression were performed. Results: 157 patients undergoing ASD surgery with minimum of 1-year follow-up were included. Mean age was 53.2 and mean instrumented levels was 13.1. Preoperative alignment was: Neutral Alignment (NA) 49%, Coronal Malalignment (CM) 17%, Sagittal Malalignment (SM 17%), and Combined Coronal/Sagittal Malalignment (CCSM) 18%. Preoperative to 1-year, and preoperative to 2-years, all ODI/SRS-22r significantly improved ( P < .001). In all patients, the only significant improvement in PROs between 1-and 2-year postoperative were those reaching ODI MCID (69% 1-year vs. 84% 2-years; P < .001). Subgroup analysis: ≥55 years had an improved median ODI (18 vs. 8; P = .047) and an improved percent achieving ODI MCID (73% vs. 84%, P = .048). CCSM patients experienced significant improvement in SRS-appearance score (75% vs. 100%; P = .050), along with those with severe preoperative SM >7.5 cm (73% vs. 100%; P = .032). Conclusions: Most ASD patients experience the majority of PRO improvement by 1-year postoperative. However, subsets of patients that may continue to improve up to 2-years postoperative include patients ≥55 years, combined coronal/sagittal malalignment, and those with severe sagittal malalignment ≥7.5 cm.

show abstract

Section: Discussionmentioning

confidence: 99%

Do Adult Spinal Deformity Patients Undergoing Surgery Continue to Improve From 1-Year to 2-Years Postoperative?

Zuckerman

Lai

Shen

et al. 2021

Global Spine Journal

View full text Add to dashboard Cite

show abstract

“…What's more, the threshold of CBD being as 30mm would be more reasonable [14] . Bao et al [19] proposed that the horizontalization of L5 was the foundation of coronal spinal alignment, in terms of addressing lumbosacral fractional curve. A population of 161 patients with DLS were absorbed in our study.…”

Section: Discussionmentioning

confidence: 99%

The predictor for Preoperative Coronal Imbalance in patients with Degenerative Lumbar Scoliosis--A related analysis on spinopelvic parameters

Zhang

Wang

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: The mechanism of coronal imbalance is still unclear. The relationships among CBD and major curve, L4 and L5 tilt have been reported, which were not explicit although. The aim of this retrospective study was to explore and examine the association between spinopelvic parameters and coronal balance distance (CBD) in degenerative lumbar scoliosis (DLS) patients.Methods Following institutional ethics approval, the radiographs of 161 DLS patients were retrospectively reviewed. The coronal measurements involving CBD, L4 coronal tilt, L5 coronal tilt, fractional curve, pelvic coronal tilt, the Cobb angle and included vertebras of major curve were documented. All of those participants were divided into group A (CBD≥30mm) and group B (CBD < 30mm). Statistical analysis was performed to compare the difference of continuous and categorical variables. Pearson-Correlation, and Multiple-Regression Analysis were performed to explore the related parameter with CBD.Results The CBD in 31 (19.25%) DLS patients at pre-operation was over 30mm. With similar major Cobb angle, main curve of patients in the group A had less involving vertebras (P=0.009), but more rotation of the apical vertebra (P<0.001) compared with that in the group B respectively. Additionally, the L4 coronal tilt in group A was much larger (P=0.02). Pearson-correlation analysis showed that CBD had significant relationship with L4/L5 coronal tilt(P<0.001), weak relationship with fractional curve (P=0.027), but linearly independent with pelvic tilt and major Cobb. Stepwise Multiple- regression analysis revealed that only L4 tilt was the independent predictor for major Cobb and CBD.Conclusions The prevalence of coronal imbalance at pre-operation in DLS patients is about 20%. With similar major Cobb, the less the number of involving vertebra, the higher the incidence of coronal imbalance in DLS patients. L4 coronal tilt would be the predictive variable for progression of scoliosis and global coronal malalignment. Pelvis, the foundation of spine, had less effect on full-spine coronal balance.

show abstract

“…Wang reported that three patients had worsening of coronal balance due to straightening of the major curve without addressing the fractional curve adequately [15]. Strategies to overcome this include accepting less major curve correction or more dedicated correction of lumbosacral fractional curve [30]. Determining coronal balance intraoperatively is difficult as long cassette radiographs could not be accessed intraoperatively in many medical centers.…”

Section: Discussionmentioning

confidence: 99%

“…Both lumbosacral fractional curve correction and major curve correction in the mid-lumbar spine are critical for the postoperative coronal balance; mismatch between them may result in the aggravation of the coronal imbalance at postoperative [ 11 , 28 – 30 ]. Wang reported that three patients had worsening of coronal balance due to straightening of the major curve without addressing the fractional curve adequately [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Posterior column osteotomy plus unilateral cage strutting for correction of lumbosacral fractional curve in degenerative lumbar scoliosis

Wang

Sun

et al. 2020

J Orthop Surg Res

View full text Add to dashboard Cite

Background Inadequate release of the posterior spinal bone elements may hinder the correction of the lumbosacral fractional curve in degenerative lumbar scoliosis, since the lumbosacral junction tends to be particularly rigid and may already be fused into an abnormal position. The purpose of this study was to evaluate the surgical outcome and complications of posterior column osteotomy plus unilateral cage strutting technique on lumbosacral concavity for correction of fractional curve in degenerative lumbar scoliosis patients. Methods Thirty-two degenerative lumbar scoliosis patients with lumbosacral fractional curve more than 15° that were surgically treated by posterior column osteotomy plus unilateral cage strutting technique were retrospectively reviewed. The patients’ medical records were reviewed to identify demographic and surgical data, including age, sex, body mass index, back pain, leg pain, Oswestry Disability Index, operation time, blood loss, and instrumentation levels. Radiological data including coronal balance distance, Cobb angle, lumbosacral coronal angle, sagittal vertical axis, lumbar lordosis, and lumbosacral lordotic angle were evaluated before and after surgery. Cage subsidence and bone fusion were evaluated at 2-year follow-up. Results All patients underwent the operation successfully; lumbosacral coronal angle changed from preoperative 20.1 ± 5.3° to postoperative 5.8 ± 5.7°, with mean correction of 14.3 ± 4.4°, and the correction was maintained at 2-year follow-up. Cobb’s angle and coronal balance distance decreased from preoperative to postoperative; the correction was maintained at 2-year follow-up. Sagittal vertical axis decreased, and lumbar lordosis increased from preoperative to postoperative; the correction was also maintained at 2-year follow-up. Lumbosacral lordotic angle presented no change from preoperative to postoperative and from postoperative to 2-year follow-up. Postoperatively, there were 8 patients with lumbosacral coronal angle more than 10°, they got the similar lumbosacral coronal angle correction, but presented larger preoperative Cobb and lumbosacral coronal angle than the other 24 patients. No cage subsidence was detected; all patients achieved intervertebral bone fusion and inter-transverse bone graft fusion at the lumbosacral region at 2-year follow-up. Conclusion Posterior column osteotomy plus unilateral cage strutting technique on the lumbosacral concavity facilitate effective correction of the fractional curve in degenerative lumbar scoliosis patients through complete release of dural sac as well as the asymmetrical intervertebral reconstruction by cage.

show abstract

Sequential correction technique to avoid postoperative global coronal decompensation in rigid adult spinal deformity: a technical note and preliminary results

Cited by 46 publications

References 19 publications

Do Adult Spinal Deformity Patients Undergoing Surgery Continue to Improve From 1-Year to 2-Years Postoperative?

Do Adult Spinal Deformity Patients Undergoing Surgery Continue to Improve From 1-Year to 2-Years Postoperative?

The predictor for Preoperative Coronal Imbalance in patients with Degenerative Lumbar Scoliosis--A related analysis on spinopelvic parameters

Posterior column osteotomy plus unilateral cage strutting for correction of lumbosacral fractional curve in degenerative lumbar scoliosis

Contact Info

Product

Resources

About