Description of the sagittal alignment of the degenerative human spine

Sebaaly, Amer; Grobost, Pierre; Mallam, Lisa; Roussouly, Pierre

doi:10.1007/s00586-017-5404-0

Cited by 97 publications

(74 citation statements)

References 24 publications

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“…Sagittal balance understanding is a primordial factor in implementing an accurate surgical strategy in degenerative spine. Recently, Sebaaly et al [11] have described the Roussouly classification for degenerative spinal diseases. But, many criticized Roussouly classifications for being described in normal population and unusable in degenerative disease, while others stated that it cannot be widely applied and that it will be poorly understood in the physician population.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

et al. 2019

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Purpose To evaluate the incidence of mechanical complications in patients with adult spine deformity (ASD) treated by restoring the normal shape according to the Roussouly classification. Methods This is a retrospective multicentric study with a minimum follow-up of 2 years. Patients operated on with fusion for ASD (minimum performed fusion: L2 to sacrum) were included. Patients with a history of previous spinal fusion of more than three levels were excluded. Spinal and pelvic parameters were measured on the preoperative and the immediate postoperative follow-up. All mechanical complications were recorded. Results A total of 290 patients met the criteria of inclusion with a minimum follow-up of 2 years. Mechanical complications occurred in 30.4% of the cohort. The most common complication was PJK with an incidence of 18% while nonunion or instrumentation failure (rod breakage, implant failure) occurred in 12.4%. 66% of the patients were restored to the normal shape according to the Roussouly classification based on their PI and had a mechanical complication rate of 22.5%, whereas the remaining 34% of patients had a complication rate of 46.8% (p < 0.001). The relative risk for developing a mechanical complication if the algorithm was not met was 3 (CI 1.5-4.3; p < 0.001) Conclusion In the recent literature, there are no clear guidelines for ASD correction. Restoring the sagittal spinal contour to the normal shapes of Roussouly according to the PI could serve as a guideline for ASD treatment. Ignoring this algorithm has a threefold risk of increased mechanical complications. We recommend this algorithm for treatment of ASD. Level of evidence IV cross-sectional observational study. Graphic abstractThese slides can be retrieved under Electronic Supplementary Material. Sebaaly AY, Gehrchen M, Silvestre C, Kharrat KE, Bari TJ, Kreichati G, Rizkallah M, Roussouly P (2019) Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study. Eur Spine J;

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Section: Discussionmentioning

confidence: 99%

“…1) [10]. Moreover, a new classification describing the evolution of the asymptomatic typology under degenerative conditions has been recently proposed by Roussouly [11] (Fig. 2).…”

Section: Introductionmentioning

confidence: 99%

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

et al. 2019

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“…The goal should be a balanced coronal spine, rather than zero straight one. The coronal plane does have an effect on the clinical picture and the postoperative failures but seems to have no statistically significant role in decision making (11,37,51) . A clinical note is that patients with a pre-operative trunk shifted to the convex side of the coronal curve are predisposed to having a post-operative coronal imbalance and should be carefully evaluated for decision-making (37,69) .…”

Section: The Coronal Curve Imbalancementioning

confidence: 99%

“…In the last decade, spine literature has been reshaped by the "new understanding of sagittal plane analysis". Significant correlations have been detected in ASD between sagittal lumbopelvic parameters and functional outcomes (4,49,51,70) . It has been shown in many studies now that positive sagittal balance is the radiographic parameter highly correlated with adverse health status measures, poor clinical outcomes, and also postoperative mechanical complications (13,24,43,57,70) .…”

Section: Sagittal Plane Deformitymentioning

confidence: 99%

Decision Making for Surgery in Adult Scoliosis Review of the Current Literature

Abul¹

2019

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Adult spinal deformity is a challenging condition in spine surgery. Adult scoliosis (AS) is an important health issue with potential to cause severe surgical adverse ramifications in aging population. Deciding who is going under the knife is still a debatable issue with no clear algorithm. This review of the recent literature is representative of the results of modern intervention methods and it references to competent authorities aiming to help clinicians to supply a guideline for surgical decision making in AS. A search in the National Library of Medicine (PubMed) database using keywords AS was performed. Our search yielded 4247 articles published between January 2005 and March 2019. When added the "surgical decision", it accounted for 105 articles. For the literature review, of papers, especially focusing on surgical decision-making, 27 were selected as guiding articles. Non-surgical interventions for symptomatic AS cases lack a high level of evidence. Successful results were reported for local decompression, limited short segment fusion, and deformity correction with long segment fusion surgeries for selected cases. Leading factors for surgery seems to be a symptomatic case with a functional problem (primarily painful radiculopathy), self-image problems, a higher curve, and recently with an extra emphasis on sagittal malalignment. Patient's expectations, pain intensity, functional status, perception of self-image and medical risk stratification, surgeon's experience, and contentment will shape the strategy needed for decision-making for surgery and whether to address either a focal pathology or comprehensive deformity correction. Every case has to be managed according to its own characteristics.

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“…Achieving an ideal spinopelvic alignment is recommended for optimal postoperative clinical outcomes. [7][8][9] Therefore, evaluations of spinal sagittal balance frequently inform surgical decision-making in lumbar degenerative disease. [10][11][12] Various lumbar interbody fusion techniques have been developed for the management of lumbar degenerative disease, and are thought to be superior to conservative treatment.…”

Section: Introductionmentioning

confidence: 99%

Lumbar degenerative disease after oblique lateral interbody fusion:sagittal spinopelvic alignment and its impact on low back pain

Zhang

Shen

et al. 2020

Preprint

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Background: We determined the incidence and risk factors of low back pain (LBP) in patients with lumbar degenerative disease after single-level oblique lateral interbody fusion (OLIF). Methods: We retrospectively reviewed 120 lumbar degenerative disease patients who underwent single-level OLIF. We compared preoperative and postoperative radiographic parameters, including segmental lordosis (SL), lumbar lordosis (LL), disk height (DH), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), C7-sagittal vertical axis (SVA). Clinical outcomes were evaluated using Oswestry Disability Index (ODI) scores and visual analog scale (VAS) scores for back and leg pain. All patients were followed up for at least 2 years. Results: Thirty-eight patients had postoperative LBP (VAS score for back pain ≥ 3; LBP group); the remaining 82 patients were in the non-LBP group. Age (P = 0.082), gender (P = 0.425), body mass index (P = 0.138), diagnosis (degenerative spondylolisthesis vs. lumbar spinal stenosis; P = 0.529), surgical level (P = 0.651), blood loss (P = 0.889), and operative time (P = 0.731) did not differ between the groups. In both groups, the ODI and VAS scores for back pain and leg pain significantly improved at the final follow-up compared to the preoperative scores (P = 0.003). Except for the VAS score for back pain (P = 0.000), none of the scores significantly differed between the two groups at the final follow-up (P > 0.05). In the non-LBP group, LL, SL, DH, TK, and SS significantly improved, while PT and C7-SVA significantly decreased at the final follow-up as compared to the preoperative values. In both groups, DH significantly improved postoperatively, with no significant between-group difference (P = 0.325). At the final follow-up, LL, PI-LL mismatch, PT, and C7-SVA showed significantly greater improvement in the non-LBP group than in the LBP group (P < 0.05). Multivariate analysis identified PT, PI-LL mismatch, and C7-SVA as significant risk factors for LBP after OLIF. Conclusion: OLIF for single-level lumbar degenerative disease had satisfactory clinical outcomes. PT, PI-LL mismatch, and C7-SVA were significant risk factors for postoperative LBP. Patients with appropriately decreased PT, improved C7-SVA, and PI-LL match experienced less LBP.

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Description of the sagittal alignment of the degenerative human spine

Abstract: Level IV cross sectional observational study.

Cited by 97 publications

References 24 publications

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

Decision Making for Surgery in Adult Scoliosis Review of the Current Literature

Lumbar degenerative disease after oblique lateral interbody fusion:sagittal spinopelvic alignment and its impact on low back pain

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