Lumbar Lordosis Minus Thoracic Kyphosis

Yang, Chen; Yang, Mingyuan; Wei, Xianzhao; Shao, Jiang; Chen, Yuanyuan; Zhao, Jian; Zhu, Xiaodong; He, Da; Li, Ming

doi:10.1097/brs.0000000000001231

Cited by 21 publications

(11 citation statements)

References 26 publications

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“…As pelvic parameters play a role in compensatory mechanisms [ 25 ], finding out the possible factors for T1 sagittal angle might be as equally important as finding out the predictors for the whole sagittal balance. In addition, our previous study [ 12 , 13 ] also found that LL and TK were important contributors to sagittal balance. Therefore, we speculated that LL and TK might play a role in maintaining T1 sagittal angle and could be changed in the surgical procedure through osteotomy to restore the whole sagittal balance.…”

Section: Discussionmentioning

confidence: 85%

“…But whether T1 sagittal angle could represent sagittal balance more accurately than other sagittal parameters including SVA, TPA (T1 pelvic angle) and T1SPI (T1 spinopelvic inclination) remains unclear. In addition, our team has found great impacts of lumbar lordosis (LL) and thoracic kyphosis (TK) on maintenance and prediction of sagittal balance, which are considered novel regional predictors for sagittal balance [ 12 , 13 ]. Therefore, we speculated that LL and TK may be important contributors to T1 sagittal angle and sagittal balance, and we could restore sagittal balance through T1 sagittal angle by changing TK and LL in the surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

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The Relationship between T1 Sagittal Angle and Sagittal Balance: A Retrospective Study of 119 Healthy Volunteers

Yang

et al. 2016

PLoS ONE

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T1 sagittal angle has been reported to be used as a parameter for assessing sagittal balance and cervical lordosis. However, no study has been performed to explore the relationship between T1 sagittal angle and sagittal balance, and whether T1 sagittal angle could be used for osteotomy guidelines remains unknown. The aim of our study is to explore the relationship between T1 sagittal angle and sagittal balance, determine the predictors for T1 sagittal angle, and determine whether T1 sagittal angle could be used for osteotomy guidelines to restore sagittal balance. Medical records of healthy volunteers in our outpatient clinic from January 2014 to August 2015 were reviewed, and their standing full-spine lateral radiographs were evaluated. Demographic and radiological parameters were collected and analyzed, including age, gender, T1 sagittal angle, maxTK, maxLL, SS, PT, and PI. Correlation coefficients between T1 sagittal angle and other spinopelvic parameters were determined. In addition, multiple regression analysis was performed to establish predictive radiographic parameters for T1 sagittal angle as the primary contributors. A total of 119 healthy volunteers were recruited in our study with a mean age of 34.7 years. It was found that T1 sagittal angle was correlated with maxTK with very good significance (r = 0.697, P<0.001), maxLL with weak significance (r = 0.206, P = 0.024), SS with weak significance (r = 0.237, P = 0.009), PI with very weak significance (r = 0.189, P = 0.039), SVA with moderate significance (r = 0.445, P<0.001), TPA with weak significance (r = 0.207, P = 0.023), and T1SPI with weak significance (r = 0.309, P = 0.001). The result of multiple regression analysis showed that T1 sagittal angle could be predicted by using the following regression equation: T1 sagittal angle = 0.6 * maxTK—0.2 * maxLL + 8. In the healthy population, T1 sagittal angle could be considered as a useful parameter for sagittal balance; however, it could not be thoroughly replaced for SVA. maxTK was the primary contributor to T1 sagittal angle. According to this equation, we could restore sagittal balance by surgically changing thoracic kyphosis and lumbar lordosis, which could serve as a guideline for osteotomy.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

The Relationship between T1 Sagittal Angle and Sagittal Balance: A Retrospective Study of 119 Healthy Volunteers

Yang

et al. 2016

PLoS ONE

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“…As we know, Schwab et al 17 brought out standardized evaluation of the sagittal plane and the goal for correction surgery in adult spinal deformity: SVA <50 mm, PI-LL <10° and PT < 25°, which had been widely used in clinical practice. Moreover, another study 18 demonstrated that LL-TK could be a good predictor for sagittal balance in Chinese elderly people, which reflected the regional compensatory mechanism and significantly associated with SVA. Our research confirmed that the pelvic parameters, the matching between spine and pelvic parameters, and the adaptation of thoracic and lumbar curvatures also played an important role for maintaining sagittal balance in patients with degenerative lumbar kyphoscoliosis.…”

Section: Discussionmentioning

confidence: 94%

Analysis of Radiographic Spinopelvic Parameters in Patients With Degenerative Lumbar Kyphoscoliosis

Yang

Liu

et al. 2021

Geriatr Orthop Surg Rehabil

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Purpose: To analyze the relationships between coronal and sagittal spinopelvic parameters in degenerative lumbar kyphoscoliosis (DLKS). Methods: We enrolled 75 patients with DLKS for a radiographic study between January 2016 and September 2018. Correlations between coronal and sagittal spinopelvic radiographic parameters were analyzed. Then patients were divided into 2 groups: sagittal balanced group (SVA< = 5 cm, 30 patients) and sagittal imbalanced group (SVA >5 cm, 45 patients), and relevant parameters were compared. Results: The Cobb angle and lumbar lordosis of the DLKS patients were 24.87 ± 11.59° and 17.26 ± 12.24°, respectively. The average age was 68 years old (range: 42-82), and the sex ratio was 2.6:1 (female: 54 patients; male: 21 patients). 50 patients (66.7%) located convexity of the curve at left side, while 25 patients (33.3%) at right side. The Cobb angle correlated with LL-TK (r = −0.228, p = 0.049), LL (r = −0.255, p = 0.027) and SS (r = −0.232, p = 0.045). There were significant differences in PI-LL (t = −3.484, P = 0.001), LL-TK (t = 2.354, P = 0.023), PI (t = −3201, P = 0.002) and PT (t = −2.521, P = 0.014) between sagittal balanced and imbalanced group. Conclusions: In degenerative lumbar kyphoscoliosis, there are some correlations between coronal and sagittal spinopelvic parameters. Moreover, PI-LL, LL-TK, PI, PT were significantly different between sagittal balanced and imbalanced DLKS patients.

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“…To rebalance the forward moving center of gravity, the compensatory mechanism involved in the spine (decrease in TK and extension of adjacent segments), pelvis (pelvic retroversion, in other words, increase in PT), and lower extremities (flexion of knee and extension of ankle). As proposed by previous study, LL-TK accounted for the local compensatory mechanism, and LL-TK > 0° could predict a good sagittal balance in elderly population since TK could decrease to compensate the loss in LL [11]. In the long-fixed spine of patients after corrective surgery, the fused sagittal alignment, including lumbar and thoracic curve, as well as pelvic rotation, limited the regional compensatory mechanism: decreased thoracic kyphosis and increased pelvic tilt.…”

Section: Discussionmentioning

confidence: 98%

“…Apart from these classical sagittal modifiers, another study demonstrated that lumbar lordosis minus thoracic kyphosis (LL-TK) could be a good predictor for sagittal balance in Chinese elderly people [11], since LL-TK reflected the regional compensatory mechanism and significantly associated with SVA. Realizing the importance of this regional predictor, we speculated that LL-TK could also be a good parameter to guide the correction surgery for patients with ADS, which has not been addressed by the previous studies.…”

Section: Introductionmentioning

confidence: 99%

Does lumbar lordosis minus thoracic kyphosis predict the clinical outcome of patients with adult degenerative scoliosis?

Zhou

et al. 2019

J Orthop Surg Res

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Purpose To evaluate the predictive effect of lumbar lordosis minus thoracic kyphosis (LL-TK) in the surgical outcome of adult degenerative scoliosis (ADS) patients and explore the optimum target base on it. Methods The preoperative and postoperative data including radiographic image and functional evaluation (Visual Analog Scale, VAS; Oswestry Disability Index, ODI; Japanese Orthopaedic Association, JOA) of 130 patients with ADS who underwent corrective surgery was retrospectively reviewed. The relationship between sagittal parameters and surgical outcome was assessed by using the Pearson correlation analysis. Receiver operating characteristic (ROC) curve was used to define the optimum cutoff value of LL-TK. Patients were divided into two groups based on LL-TK to compare the preoperative and postoperative status. Results LL-TK assessed soon after surgery strongly correlated with health-related quality of life (HRQOL) and sagittal vertical axis (SVA) at last follow-up. The cutoff value of LL-TK was set at 10° to determine a good clinical outcome (ODI < 20) and sagittal balance (SVA < 50 mm). Patients with LL-TK > 10° presented significantly better postoperative VAS, ODI, JOA, and SVA than patients with LL-TK < 10°. Conclusion LL-TK could effectively predict postoperative HRQOL and sagittal balance for patients with ADS. Patients with LL-TK > 10° showed a better clinical outcome and sagittal balance, so LL-TK > 10° could be the optimum corrective target for these patients.

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Lumbar Lordosis Minus Thoracic Kyphosis

Abstract: 4.

Cited by 21 publications

References 26 publications

The Relationship between T1 Sagittal Angle and Sagittal Balance: A Retrospective Study of 119 Healthy Volunteers

The Relationship between T1 Sagittal Angle and Sagittal Balance: A Retrospective Study of 119 Healthy Volunteers

Analysis of Radiographic Spinopelvic Parameters in Patients With Degenerative Lumbar Kyphoscoliosis

Does lumbar lordosis minus thoracic kyphosis predict the clinical outcome of patients with adult degenerative scoliosis?

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