Adult Spinal Deformity—Postoperative Standing Imbalance

Schwab, Frank J.; Patel, Ashish; Ungar, Benjamin; Farcy, Jean-Pierre; Lafage, Virginie

doi:10.1097/brs.0b013e3181ee6bd4

Cited by 958 publications

(364 citation statements)

References 18 publications

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“…Tao et al [29] have suggested that hybrid construct were not likely to prevent crankshaft phenomenon when compared to pedicle screws construct. This complication is essentially encountered with skeletally immature patients, and was not seen in our series as all patients showed a closed triradiate cartilage at the time of surgery.…”

Section: Hybrid Constructs and Kyphosis Correctionmentioning

confidence: 99%

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

et al. 2012

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Purpose Surgical adolescent idiopathic scoliosis (AIS) management can be associated with loss of thoracic kyphosis and a secondary loss of lumbar lordosis leading to iatrogenic flatback. Such conditions are associated with poorer clinical outcomes during adulthood. The aim of this study was to evaluate sagittal plane reciprocal changes after posterior spinal fusion in the setting of AIS. Methods Thirty consecutive adolescents (mean age 14.6 years) with AIS Lenke 1, 2 or 3 were included in this retrospective study with 2 year follow-up. Full-spine standing coronal and lateral radiographs were obtained preoperatively, at 3 and 24 months postoperatively. Coronal Cobb angle, thoracic kyphosis (TK) and lumbar lordosis (LL) were measured. Surgical procedure was similar in all the cases, with use of pedicular screws between T11 and the lowest instrumented vertebra (CL2), sublaminar hooks applied in compression at the upper thoracic level and sub-laminar bands and clamps in the concavity of the deformity. Statistical analysis was done using t test and Pearson correlation coefficient. Results Between preoperative and last follow-up evaluations a significant reduction of Cobb angle was observed (53.6°vs. 17.2°, p \ 0.001). A significant improvement of the instrumented thoracic kyphosis, TK (19.7°vs. 26.2°, p \ 0.005) was noted, without difference between 3 and 24 months postoperatively. An improvement in lumbar lordosis, LL (43.9°vs. 47.3°, p = 0.009) was also noted but occurred after the third postoperative month. A significant correlation was found between TK correction and improvement of LL (R = 0.382, p = 0.037), without correlation between these reciprocal changes and the amount of coronal correction. Conclusion Results from this study reveal that sagittal reciprocal changes occur after posterior fusion when TK is restored. These changes are visible after 3 months postoperatively, corresponding to a progressive adaptation of patient posture to the surgically induced alignment. These changes are not correlated with coronal plane correction of the deformity. In the setting of AIS, TK restoration is a critical goal and permits favorable postural adaptation. Further studies will include pelvic parameters and clinical scores in order to evaluate the impact of the noted reciprocal changes.

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Section: Hybrid Constructs and Kyphosis Correctionmentioning

confidence: 99%

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

et al. 2012

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“…For follow-up radiographs, the difference between a predicted high lumbar lordosis L1-S1, as by the equation LL = PI ? 9° [5], and the real lumbar lordosis was calculated Eur Spine J (2014) 23:180-191 183 The vertebra above the first disc revealing lordotic wedging is usually selected as the lowest instrumented vertebra (LIV). The selection of LIV also addresses the concerns of increased biomechanical stress at the thoracolumbar junction.…”

Section: Correctionmentioning

confidence: 99%

Surgical treatment of Scheuermann’s kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases

et al. 2013

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Introduction There is sparse literature on how best to correct Scheuermann's kyphosis (SK). The efficacy of a combined strategy with anterior release and posterior fusion (AR/PSF) with regard to correction rate and outcome is yet to be determined. Materials and methods A review of a consecutive series of SK patients treated with AR/PSF using pedicle screwrod systems was performed. Assessment of demographics, complications, surgical parameters and radiographs including flexibility and correction measures, proximal junctional kyphosis angle (JKA ? 1) and spino-pelvic parameters was performed, focusing on the impact of curve flexibility on correction and clinical outcomes. Results 111 patients were eligible with a mean age of 23 years, follow-up of 24 months and an average of eight levels fused. Cobb angle at fusion level was 68°preoper-atively and 37°postoperatively. Flexibility on traction films was 34 % and correction rate 47 %. Postoperative and follow-up Cobb angles were highly correlated with preoperative bending films (r = 0.7, p \ 0.05). Screw density rate was 87 %, with increased correction with higher screw density (p \ 0.001, r = 0.4). Patients with an increased junctional kyphosis angle (JKA ? 1) were at higher risk of revision surgery (p = 0.049). 22 patients sustained complication, and 21 patients had revision surgery. 42 patients with C24 months follow-up were assessed for clinical outcomes (follow-up rate for clinical measures was 38 %). This subgroup showed no significant differences regarding baseline parameters as compared to the whole group. Median approach-related morbidity (ArM) was 8.0 %, SRS-sum score was 4.0, and ODI was 4 %. There was a significant negative correlation between the SRS-24 self-image scores and the number of segments fused (r = -0.5, p \ 0.05). Patients with additional surgery had decreased clinical outcomes (SRS-24 scores, p = 0.004, ArM, p = 0.0008, and ODI, p = 0.0004). Conclusion The study highlighted that AR/PSF is an efficient strategy providing reliable results in a large singlecenter series. Results confirmed that flexibility was the decisive measure when comparing surgical outcomes with different treatment strategies. Findings indicated that changes at the proximal junctional level were impacted by individual spino-pelvic morphology and determined by the individually predetermined thoracolumbar curvature and sagittal balance. Results stressed that in SK correction, reconstruction of a physiologic alignment is decisive to achieving good clinical outcomes and avoiding complications.

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“…Moreover, it has also been proven that applying this method is directly related to improving the health and quality of the life of the patients with AIS (11,12). The patients who have significantly lost their lordosis often need to spend high energy and a compensatory and painful mechanism such as pelvic retroversion to maintain their gravity line and balance (13,14). The concept of spinopelvic compensatory mechanism was explained by some French researchers over 20 years ago, but it was published in the English-language papers for the first time in the past decade (15).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Factors Affecting the Loss of Lumbar Lordosis in Surgical Treatment of Patients with Adolescent Idiopathic Scoliosis Using Segmental Instrumentation

et al. 2017

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Background: The identification of independent factors affecting the loss of lumbar lordosis can facilitate programmed surgery in adolescent idiopathic scoliosis (AIS) patients especially with considering the importance of sagittal characteristics. Objectives: This study aimed to investigate the factors affecting the amount of the loss of lumbar lordosis in surgical treatment of the patients with AIS using segmental instrumentation. Methods: In this study which was conducted in three years, 91 AIS patients who underwent segmental instrumentation were studied and 63 patients remained in the study according to the inclusion criteria. All patients' information was recorded on admission in separate forms and radiography results were coded and archived before the surgery for more evaluation. All patients were subject to standing whole spine radiograph again 12 months after the surgery. Ultimately, the information was put into predetermined forms and was used for a statistical analysis after the completion of forms.

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Adult Spinal Deformity—Postoperative Standing Imbalance

Cited by 958 publications

References 18 publications

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

Surgical treatment of Scheuermann’s kyphosis using a combined antero-posterior strategy and pedicle screw constructs: efficacy, radiographic and clinical outcomes in 111 cases

Evaluation of the Factors Affecting the Loss of Lumbar Lordosis in Surgical Treatment of Patients with Adolescent Idiopathic Scoliosis Using Segmental Instrumentation

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