Orientation of L4 coronal tilt relative to C7 plumb line as a predictor for postoperative coronal imbalance in patients with degenerative lumbar scoliosis

Zhang, Jiandang; Wang, Zheng; Chi, Pengfei; Chi, Cheng

doi:10.1038/s41598-020-73352-1

Cited by 9 publications

(8 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: 59%

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: 59%

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

Ruffilli

Barile

Paolucci

et al. 2023

JCM

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“…It has been suggested that patients with different preoperative CM types can have different surgical outcomes. Zhang et al showed that the incidence of postoperative coronal imbalance was significantly higher in patients with preoperative Obeid type 2 than in those with preoperative Obeid type 1 [ 26 ]. They examined an ASD patient who underwent deformity correction surgery with a posterior-only approach in their case series.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Radiological Improvement after Staged Surgery Using Lateral Lumbar Interbody Fusion for Preoperative Coronal Malalignment in Patients with Adult Spinal Deformity

Hiyama

Sakai

Katoh

et al. 2023

JCM

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This retrospective observational study evaluated improvement in coronal malalignment (CM) after anteroposterior staged surgery using lateral lumbar interbody fusion (LLIF) in patients with coronal lumbar curve adult spinal deformity (ASD). Sixty patients with ASD underwent surgery; 34 had SRS–Schwab type L lumbar curve. Patients with a coronal balance distance (CBD) ≥20 mm were diagnosed with CM. Using the Obeid CM classification, we classified the preoperative coronal pattern as concave CM (type 1) or convex CM (type 2). Demographic, surgical, and radiological parameters were compared. Whole-spine standing radiographs were assessed preoperatively and postoperatively. Twenty-three patients had type 1A, six had type 2A, five had no CM, and none had type 1B or 2B according to the Obeid CM classification. Compared with patients with Obeid type 1A, those with Obeid type 2A had significantly higher preoperative and postoperative coronal L4 tilts and a smaller change in corrected CBD (Δ|CBD|) (76.6 mm vs. 24.1 mm, p < 0.001). At the final follow-up, 58.6% (17/29 patients) of patients with SRS–Schwab type L CM showed improvement after corrective fusion using LLIF. Although the difference was not statistically significant, CM improved in 69.6% (16/23 patients) of patients with Obeid type 1A type but only 16.7% (1/6 patients) of those with Obeid type 2A type (p = 0.056). CM was more likely to remain after anteroposterior staged surgery using LLIF in patients with preoperative Obeid type 2A ASD.

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“…Similarly, Lewis et al 17 reported the relationship between L4/5 tilt and postoperative CIB. Zhang et al [13][14][15] discovered that the consistency between the C7 PL and L4 tilt direction was associated with CIB. Another study 16 also proposed that the coronal T1 pelvic tilt angle was a practical index to evaluate CBD.…”

Section: Discussionmentioning

confidence: 99%

“…reported the relationship between L4/5 tilt and postoperative CIB. Zhang et al 13–15 . discovered that the consistency between the C7 PL and L4 tilt direction was associated with CIB.…”

Section: Discussionmentioning

confidence: 99%

“…Shu et al 12 reported that not only the C7 PL pointing to the convex side but upper instrumented vertebra (UIV) above T6 and lower instrumented vertebra (LIV) rotation were also risk factors. Furthermore, studies [13][14][15] discovered a correlation between C7 PL and L4 tilt direction to CIB after surgery. Additionally, coronal T1 pelvic tilt, 16 L4/5 tilt, 17,18 and imbalanced correction ratio between the thoracolumbar/lumbar (TL/L) and lumbosacral (LS) curves 6 were found to be associated with postoperative CIB.…”

mentioning

confidence: 99%

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Risk Factors of Postoperative Coronal Balance Transition in Degenerative Lumbar Scoliosis

Ding,

Sun,

et al. 2023

Spine

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Study Design. Retrospective radiographic study. Objective. To determine the potential risk factors influencing the transition of postoperative coronal balance in degenerative lumbar scoliosis (DLS) patients. Summary of Background Data. As time passes after surgery, the spinal sequence of DLS patients may dynamically shift from coronal balance to imbalance, causing clinical symptoms. However, the transition of postoperative coronal balance and its risk factors have not been effectively investigated. Methods. We included 156 DLS patients. The cohort was divided into immediate postoperative coronal balance with follow-up balance (N=73) and follow-up imbalance (N=21), immediate postoperative coronal imbalance with follow-up balance (N=23) and follow-up imbalance (N=39). Parameters included age, sex, classification of coronal balance, coronal balance distance, fusion of L5 or S1, location of apical vertebra, apical vertebral translation (AVT), Cobb angle of main curve and lumbar-sacral curve, tilt and direction of L4/5, tilt and direction of upper instrumented vertebra (UIV), and Cobb angle of T1-UIV. Statistical testing was performed using chi-square/Fisher’s exact test, t-tests or non-parametric tests, correlation testing, and stepwise logistic regression. Results. We identified a significant difference in preoperative AVT, preoperative Cobb angle, and immediate postoperative UIV tilt between patients with and without follow-up balance. Logistic regression analysis demonstrated factors associated with follow-up coronal imbalance included preoperative AVT (P=0.015), preoperative Cobb angle (P=0.002), tilt of immediate postoperative UIV (P=0.018). Factors associated with immediate postoperative coronal imbalance patients with follow-up coronal balance were sex, correction ratio of main curve, and direction of L4. Logistic regression analysis further identified a correction ratio of main curve≤0.7 (P=0.009) as an important predictive factor. Conclusion. Patients with immediate postoperative coronal balance and higher preoperative AVT, preoperative Cobb angle, and tilt of immediate postoperative UIV were more likely to experience follow-up coronal imbalance. A correction ratio of main curve≤0.7 was an independent predictor of follow-up coronal imbalance. Level of Evidence. 3

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Orientation of L4 coronal tilt relative to C7 plumb line as a predictor for postoperative coronal imbalance in patients with degenerative lumbar scoliosis

Cited by 9 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

Postoperative Radiological Improvement after Staged Surgery Using Lateral Lumbar Interbody Fusion for Preoperative Coronal Malalignment in Patients with Adult Spinal Deformity

Risk Factors of Postoperative Coronal Balance Transition in Degenerative Lumbar Scoliosis

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