Cervical spine alignment following lumbar pedicle subtraction osteotomy for sagittal imbalance

Obeid, Ibrahim; Boniello, Anthony J.; Boissière, Louis; Bourghli, Anouar; Pointillart, Vincent; Gille, Olivier; Lafage, Virginie; Vital, Jean-Marc

doi:10.1007/s00586-014-3738-4

Cited by 34 publications

(22 citation statements)

References 42 publications

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“…This hypokyphotic thoracic posture with posterior pelvic displacement assumed for maximum compensation with positive SVA and inadequate LL has been described. 15,34,35 Moreover, patients overcorrected in PI-LL displayed a comparable profile as previously described by Ferrero et al 16 : heightened hip extension and thoracic kyphosis, with anterior pelvic displacement acting as compensation, with overall neutral global alignment and low PT. 16 Consistent with the smaller PI-LL correction (D À4.58) in age-undercorrected patients, Jang et al noted a strong correlation between the lumbar correction angle and the spontaneous postoperative thoracic curve change.…”

Section: Postoperative Correction Groupssupporting

confidence: 69%

Full-Body Radiographic Analysis of Postoperative Deviations From Age-Adjusted Alignment Goals in Adult Spinal Deformity Correction and Related Compensatory Recruitment

et al. 2019

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Background: Full-body stereographs for adult spinal deformity (ASD) have enhanced global deformity and lower-limb compensation associations. The advent of age-adjusted goals for classic ASD parameters (sagittal vertical axis, pelvic tilt, spino-pelvic mismatch [PI-LL]) has enabled individualized evaluation of successful versus failed realignment, though these remain to be radiographically assessed postoperatively. This study analyzes pre-and postoperative sagittal alignment to quantify patient-specific correction against age-adjusted goals, and presents differences in compensation in patients whose postoperative profile deviates from targets. Methods: Single-center retrospective review of ASD patients ! 18 years with biplanar full-body stereographic xrays. Inclusion: ! 4 levels fused, complete baseline and early (6-month) follow-up imaging. Correction groups generated at postoperative visit for actual alignment compared to age-adjusted ideal values for pelvic tilt, PILL , and sagittal vertical axis derived from clinically relevant formulas. Patients that matched exact 6 10-year threshold for ageadjusted targets were compared to unmatched cases (undercorrected or overcorrected). Comparison of spinal alignment and compensatory mechanisms (thoracic kyphosis, hip extension, knee flexion, ankle flexion, pelvic shift) across correction groups were performed with ANOVA and paired t tests. Results: The sagittal vertical axis, pelvic tilt, and PILL of 122 patients improved at early postoperative visits (P , .001). Of lower-extremity parameters, knee flexion and pelvic shift improved (P , .001), but hip extension and ankle flexion were similar (P. .170); global sagittal angle decreased overall, reflecting global postoperative correction (8.38 versus 4.48, P , .001). Rates of undercorrection to age-adjusted targets for each spino-pelvic parameter were 30.3% (sagittal vertical axis), 41.0% (pelvic tilt), and 43.6% (PI-LL). Compared to matched/overcorrections, undercorrections recruited increased posterior pelvic shift to compensate (P , .001); knee flexion was recruited in undercorrections for sagittal vertical axis and pelvic tilt; thoracic hypokyphosis was observed in PILL undercorrections. All undercorrected groups displayed consequentially larger global sagittal angle (P , .001). Conclusions: Global alignment cohort improvements were observed, and when comparing actual to age-adjusted alignment, undercorrections recruited pelvic and lower-limb flexion to compensate.

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Section: Postoperative Correction Groupssupporting

confidence: 69%

Full-Body Radiographic Analysis of Postoperative Deviations From Age-Adjusted Alignment Goals in Adult Spinal Deformity Correction and Related Compensatory Recruitment

et al. 2019

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“…But we found no signi cant differences between the preoperative value and the ultimate follow-up value in CrSVA-S and CrSVA-H, which means C7SVA is less sensitive than CrSVA-S and CrSVA-H in detecting mild deterioration of global sagittal balance. It was also reported CrSVA was more correlated with ODI and all SRS subscores than C7SVA [7], which could not consider the motion of cervical spine [21]. But we still think further investigation of cranial parameters is warranted to clarify their meaning as global alignment parameters.…”

Section: Discussionmentioning

confidence: 92%

Radiographic and Clinical Evidence: Osteoarthritic Knee Can Change Surgical Result for Lumbar Degenerative Disease Patient Undergone Surgery for 3-year Follow-up: A Retrospective Comparative Clinical Study

Kim

et al. 2020

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Background : There is a paucity of reports clarifying the implication of knee osteoarthritis (OA) on spinal sagittal alignment of patients undergone surgery for lumbar spine. This study aimed to analyze how osteoarthritic knee affects radiographic and clinical results of degenerative lumbar disease patients undergone lumbar fusion. Methods : We retrospectively reviewed the medical records and radiographs of 74 consecutive degenerative lumbar disease patients who underwent posterior instrumentation and fusion surgery between May 2016 and June 2017 and were followed up for minimum 3 years postoperatively. The patients were divided into 2 groups according to the severity of knee OA by Kellgren-Lawrence grading (KLG) scale (group I, KLG 1 or 2 [n=39]; group II, KLG 3 or 4 [n=35]). Patient demographic data, comorbidities, spinal sagittal parameters and clinical scores were extracted and compared at preoperative, postoperative 1 month and the ultimate follow-up between the groups. In radiographic assessment, sagittal alignment parameters and sagittal balance were used. In clinical assessment, the scores of Oswestry disability index (ODI) and Scoliosis Research Society questionnaire (SRS-22) were used. For the frequency analysis of categorical variables across the groups, chi-square test was used and student t tests was used to assess the differences of continuous variables. Results : In radiographic assessment, TLK(thoracolumbar kyphosis), LL(lumbar lordosis), PT(pelvic tilt), C7 SVA(sagittal vertical axis) in both groups improved significantly after surgery(p<0.05). However, LL, PT, C7SVA improved at postoperative 1 month in the group II were not maintained at the ultimate postoperative follow-up. In clinical assessment, preoperative Oswestry disability index (ODI, %) and all SRS-22 subscores of the group I and II were not different (p>0.05). There were significant differences between the groups at the ultimate follow-up in ODI (-25.6 vs -12.1, p<0.001), SRS total score (%) (28 vs 20, p=0.037), function subscore (1.4 vs 0.7, p=0.016), and satisfaction subscore (1.6 vs 0.6, p<0.001). Conclusion: Osteoarthritic knee with KLG 3 or 4 have a negative influence on maintaining postoperative spinal sagittal alignment, balance, and the clinical outcomes achieved immediately by posterior instrumentation and fusion for lumbar degenerative disease.

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“…In our clinical practice, some patients showed relatively poor improvement of clinical scores although we have assessed improvement in spinal sagittal balance for them with C7 SVA after surgical correction. The C7 SVA, which means a plumb line from the 7th cervical vertebra to the sacrum, is limited to the evaluation of thoracic and lumbar spine instead of the whole spine include the cervical, and let alone the lower limbs, so it is not sufficient in evaluating global balance of the patient [20][21][22].…”

Section: Resultsmentioning

confidence: 99%

The difference of whole-body sagittal alignment in different postures in young, healthy adults

Xue

Shen²,

Dai³

2020

Preprint

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Study DesignProspective study.ObjectiveTo identify the differences of radiographic between standard upright position and natural and comfortable upright position.MethodsRadiographic parameters of 50 young and healthy adults were evaluated including the global cervical angle (GCA), global thoracic angle (GTA), global lumbar angle (GLA), which were used to depict the spine profile; the distance from the cranial sagittal vertical axis (CSVA) to the posterior corner of S1(CSVA-S), the center of the hip(CSVA-H), the center of the knee(CSVA-K) and the ankle(CSVA-A), respectively in both upright positions and natural and comfortable upright position, which were employed to describe the whole-body balance.ResultsSignificant differences could be observed in all the GCA(17.39 ± 6.90 vs. 10.90 ± 3.77, p < .001), GTA(25.63 ± 7.27 vs. 45.42 ± 8.15 p < .001), GLA(42.64 ± 8.05 vs. 20.21 ± 7.47 p < .001), CSVA-S(0.33 ± 2.76 cm vs. 8.54 ± 3.78 cm, p < 0.001), CSVA-H(1.53 ± 3.11 cm vs. 5.71 ± 3.26 cm, p < 0.001), CSVA-K(3.58 ± 2.47 cm vs. 5.22 ± 2.69 cm, p = 0.002) and CSVA-A(1.79 ± 1.92 cm vs. 4.79 ± 2.51 cm, p < 0.001) in the two different standing postures, respectively. Compared with standard upright position, natural and comfortable upright position results in a more kyphotic spine profile.ConclusionSignificant differences in sagittal radiographic parameters were found between the standard upright position and natural and comfortable upright position, with the latter revealing a more kyphotic spinal profile more common in everyday life, which may explain the existing spinal pathologies as well as predict postoperative complications. The natural and comfortable upright position should be a factor to consider when performing a surgical plan.

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Cervical spine alignment following lumbar pedicle subtraction osteotomy for sagittal imbalance

Cited by 34 publications

References 42 publications

Full-Body Radiographic Analysis of Postoperative Deviations From Age-Adjusted Alignment Goals in Adult Spinal Deformity Correction and Related Compensatory Recruitment

Full-Body Radiographic Analysis of Postoperative Deviations From Age-Adjusted Alignment Goals in Adult Spinal Deformity Correction and Related Compensatory Recruitment

Radiographic and Clinical Evidence: Osteoarthritic Knee Can Change Surgical Result for Lumbar Degenerative Disease Patient Undergone Surgery for 3-year Follow-up: A Retrospective Comparative Clinical Study

The difference of whole-body sagittal alignment in different postures in young, healthy adults

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