The role of the fractional lumbosacral curve in persistent coronal malalignment following adult thoracolumbar deformity surgery: a radiographic analysis

Theologis, Alekos A; Lertudomphonwanit, Thamrong; Lenke, Lawrence G.; Gupta, Munish C.

doi:10.1007/s43390-020-00228-9

Cited by 10 publications

(16 citation statements)

References 15 publications

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“…This result was confirmed by other authors, who explained it with an inadequate correction of the lumbosacral fractional curve [5,15]. However, while some authors have analyzed the influence of the preoperative trunk shift on the postoperative balance [5,15], and others studied the L4 and L5 tilt [16][17][18], as far as the authors know, there is no study evaluating the correlation of all these preoperative variables (trunk shift, L4 tilt, L5 tilt, and sagittal parameters) on the postoperative balance, providing a comprehensive understanding of the preoperative radiographical risk factors for CIB. The aim of the present study was to elucidate preoperative risk factors for inadequate correction of coronal imbalance and/or creation of new postoperative coronal imbalance (iatrogenic CIB) in patients who undergo surgery for Adult Spinal Deformity (ASD).…”

Section: Introductionsupporting

confidence: 63%

“…In the present study, preoperatively balanced (type A) and imbalanced (type B and C) patients did not differ significantly on the coronal plane (lumbosacral fractional curve severity, L4, and L5 tilt). However, postoperatively, type C patients showed the highest postoperative CVA (p = 0.04, η 2 0.3) and the highest L4 tilt angle (15.7 ± 5.2, p = 0.005), while the major curve Cobb angle was similar between the groups: this might indicate that, in type C patients, correction of the major curve has been excessive and not tailored to match correction of the LSF curve, failing to restore a good balance [14,16,19]. Our result is in line with the existing literature [5,14].…”

Section: Discussionmentioning

confidence: 98%

“…Our result is in line with the existing literature [5,14]. An explanation for the high risk of CIB in patients with a preoperative type C imbalance can be found in the surgical strategy: in fact, traditional approaches aiming to correct coronal deformities consist of achieving distraction of the concave side and compression of the convex side (for example, by placing cages in concavity or by performing asymmetric tricolumn osteotomies); however, while these maneuvers can correct the coronal plane in type A and B patients, they may aggravate the inclination of the trunk in type Cs [14,16,17]. As for independent risk factors, the multivariate analysis demonstrated that preoperative L5 tilt is an independent risk factor for both postoperative coronal imbalance (CIB, p = 0.007) and iatrogenic imbalance (iCIB, p = 0.01).…”

Section: Discussionmentioning

confidence: 99%

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Independent Risk Factors of Postoperative Coronal Imbalance after Adult Spinal Deformity Surgery

Ruffilli

Barile

Paolucci

et al. 2023

JCM

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The aim of the present study is to elucidate preoperative risk factors for inadequate correction of coronal imbalance and/or creation of new postoperative coronal imbalance (iatrogenic CIB) in patients who undergo surgery for Adult Spinal Deformity (ASD). A retrospective review of adults who underwent posterior spinal fusion (>5 levels) for ASD was performed. Patients were divided into groups according to the Nanjing classification: type A (CSVL < 3 cm), type B (CSVL > 3 cm and C7 plumb line shifted to major curve concavity), and type C (CSVL > 3 cm and C7 plumb line shifted to major curve convexity). They were also divided according to postoperative coronal balance in balanced (CB) vs. imbalanced (CIB) and according to iatrogenic coronal imbalance (iCIB). Preoperative, postoperative, and last follow-up radiographical parameters and intraoperative data were recorded. A multivariate analysis was performed to identify independent risk factors for CIB. A total of 127 patients were included (85 type A, 30 type B, 12 type C). They all underwent long (average levels fused 13.3 ± 2.7) all-posterior fusion. Type C patients were more at risk of developing postoperative CIB (p = 0.04). Multivariate regression analysis indicated L5 tilt angle as a preoperative risk factor for CIB (p = 0.007) and indicated L5 tilt angle and age as a preoperative independent risk factors for iatrogenic CIB (p = 0.01 and p = 0.008). Patients with a preoperative trunk shift towards the convexity of the main curve (type C) are more prone to postoperative CIB and leveling the L4 and L5 vertebrae is the key to achieve coronal alignment preventing the “takeoff phenomenon”.

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Section: Introductionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Independent Risk Factors of Postoperative Coronal Imbalance after Adult Spinal Deformity Surgery

Ruffilli

Barile

Paolucci

et al. 2023

JCM

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“…Accordingly, our research team developed a new classification system, namely Nanjing classification, based on preoperative coronal balance distance (CBD) and inclination pattern. Importantly, this system has provided new insights regarding surgical decision-making, especially for patients with type C who prone to coronal imbalance after 3-column osteotomy (15)(16)(17)(18). Although, lumbosacral fractional curve, L4 tilt and apex location were shown to be related to coronal imbalance, there remains a scarce of literature comprehensively describing etiology of different pattern of coronal imbalance (18).…”

Section: Introductionmentioning

confidence: 99%

“…Importantly, this system has provided new insights regarding surgical decision-making, especially for patients with type C who prone to coronal imbalance after 3-column osteotomy (15)(16)(17)(18). Although, lumbosacral fractional curve, L4 tilt and apex location were shown to be related to coronal imbalance, there remains a scarce of literature comprehensively describing etiology of different pattern of coronal imbalance (18). Hence, we speculated that paraspinal muscle degeneration may variate among the different subtypes based on our Nanjing classification.…”

Section: Introductionmentioning

confidence: 99%

The role of paraspinal muscle degeneration in coronal imbalance in patients with degenerative scoliosis

Kiram¹,

Hu²,

Man³

et al. 2022

Quant Imaging Med Surg

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Background Coronal imbalance in degenerative scoliosis is common and is highly correlated with health-related quality of life. Paraspinal muscle is critical to spine stability, but little is known about its contribution to coronal imbalance in degenerative scoliosis. This study aims to investigate the relationship between paraspinal muscle (PSM) degeneration and coronal imbalance in patients with degenerative scoliosis (DS). Methods This is a retrospective cohort study. A total of 117 patients with DS were retrospectively reviewed. Parameters of PSM (bilateral cross-sectional area, CSA; fat infiltration rate, FI%) at the apical disc and adjacent levels were quantitatively evaluated using MRI. Standing whole-spine radiograph was used to evaluate the coronal (Cobb angle, CA; coronal balance distance, CBD) and sagittal (thoracic kyphosis, TK; lumbar lordosis, LL; sagittal vertical axis, SVA) parameters. Patients were divided into 3 groups: coronal balanced (Type A), coronal imbalanced shifting to concavity (Type B), and coronal imbalanced shifting to convexity (Type C). Results Based on our criteria, 56 patients were assigned to Type A, 34 patients to Type B, and 27 patients to Type C. There was no significant difference on the sagittal profiles and CSA between the groups. However, Type A showed significantly lower FI% than Type B and Type C on both concavity and convexity (Concave side: Type A vs. Type B vs. Type C, 30.8±8.1 vs. 45.1±7.7 vs. 38.7±12.5, P=0.001; Convex side: Type A vs. Type B vs. Type C, 32.6±10.9 vs. 46.3±7.3 vs. 40.7±11.8, P=0.004). Specifically, Cobb angle was negatively correlated with CSA, mainly at convexity (R=−0.415, P=0.008). Similarly, the increase of CBD significantly correlated with FI% at concavity (R=0.491, P=0.001) and convexity (R=0.354, P=0.025). Conclusions DS patients with coronal imbalance demonstrated a worse PSM degeneration when compared with those without coronal imbalance. Besides, PSM degeneration strongly correlated with coronal imbalance, which implies that PSM degeneration may contribute to the coronal imbalance in patients with DS.

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Adherence to the Obeid coronal malalignment classification and a residual malalignment below 20 mm can improve surgical outcomes in adult spine deformity surgery

et al. 2023

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Purpose Coronal balance is a major factor impacting the surgical outcomes in adult spinal deformity (ASD). The Obeid coronal malalignment (O-CM) classification has been proposed to improve the coronal alignment in ASD surgery. Aim of this study was to investigate whether a postoperative CM < 20 mm and adherence to the O-CM classification could improve surgical outcomes and decrease the rate of mechanical failure in a cohort of ASD patients. Methods Multicenter retrospective analysis of prospectively collected data on all ASD patients who underwent surgical management and had a preoperative CM > 20 mm and a 2-year follow-up. Patients were divided in two groups according to whether or not surgery had been performed in adherence to the guidelines of the O-CM classification and according to whether or not the residual CM was < 20 mm. The outcomes of interest were radiographic data, rate of mechanical complications and Patient-Reported Outcome Measures. Results At 2 years, adherence to the O-CM classification led to a lower rate of mechanical complications (40 vs. 60%). A coronal correction of the CM < 20 mm allowed for a significant improvement in SRS-22 and SF-36 scores and was associated with a 3.5 times greater odd of achieving the minimal clinical important difference for the SRS-22. Conclusion Adherence to the O-CM classification could reduce the risk of mechanic complications 2 years after ASD surgery. Patients with a residual CM < 20 mm showed better functional outcomes and a 3.5 times greater odd of achieving the MCID for the SRS-22 score.

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The role of the fractional lumbosacral curve in persistent coronal malalignment following adult thoracolumbar deformity surgery: a radiographic analysis

Cited by 10 publications

References 15 publications

Independent Risk Factors of Postoperative Coronal Imbalance after Adult Spinal Deformity Surgery

Independent Risk Factors of Postoperative Coronal Imbalance after Adult Spinal Deformity Surgery

The role of paraspinal muscle degeneration in coronal imbalance in patients with degenerative scoliosis

Adherence to the Obeid coronal malalignment classification and a residual malalignment below 20 mm can improve surgical outcomes in adult spine deformity surgery

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