Sagittal spinopelvic alignment after spinal fusion in degenerative lumbar scoliosis: a meta-analysis

Eun, Il-Soo; Son, Seung Min; Goh, Tae Sik; Lee, Jung Sub

doi:10.1080/02688697.2020.1725437

Cited by 7 publications

(3 citation statements)

References 40 publications

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“…Low PI, low LL, and high pelvic tilt are associated with increased ASD incidence [24]. The correction of these parameters to within normal limits with expandable cages or hyperlordotic implants may improve patient-reported outcome measures (PROMs) [25][26][27][28].…”

Section: Correctionmentioning

confidence: 99%

Emerging Technologies within Spine Surgery

Foley,

Hardacker,

McCarthy

2023

Life

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New innovations within spine surgery continue to propel the field forward. These technologies improve surgeons’ understanding of their patients and allow them to optimize treatment planning both in the operating room and clinic. Additionally, changes in the implants and surgeon practice habits continue to evolve secondary to emerging biomaterials and device design. With ongoing advancements, patients can expect enhanced preoperative decision-making, improved patient outcomes, and better intraoperative execution. Additionally, these changes may decrease many of the most common complications following spine surgery in order to reduce morbidity, mortality, and the need for reoperation. This article reviews some of these technological advancements and how they are projected to impact the field. As the field continues to advance, it is vital that practitioners remain knowledgeable of these changes in order to provide the most effective treatment possible.

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Section: Correctionmentioning

confidence: 99%

Emerging Technologies within Spine Surgery

Foley,

Hardacker,

McCarthy

2023

Life

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“…Nevertheless, literature regarding the regression of postoperative CIB was limited. Recent articles [26][27][28] reported a progressive loss of sagittal balance after degenerative scoliosis has been corrected, indicating that most elderly patients have compensatory ability and alteration of postoperative sagittal balance. Thus, when monitoring the postoperative CB, particularly for patients with immediate balance after surgery, it is important to pay attention to the dynamic change process during the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

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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“…The historical target was "as much lordosis as possible." This continued until several authors, including Schwab et al and Lafage et al, proposed matching PI to LL within 10°, which has been shown to improve outcomes even in surgical procedures for degenerative pathology 35,[40][41][42][43][44][45][46][47][48][49][50][51] . It has been suggested to correct LL to PI 1 10°if the PI is low and to PI 2 10°if the PI is high 52 .…”

mentioning

confidence: 99%

Sagittal Alignment in the Degenerative Lumbar Spine

Diebo,

Balmaceno-Criss,

Lafage

et al. 2024

Journal of Bone and Joint Surgery

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➤ Sagittal alignment of the spine has gained attention in the field of spinal deformity surgery for decades. However, emerging data support the importance of restoring segmental lumbar lordosis and lumbar spinal shape according to the pelvic morphology when surgically addressing degenerative lumbar pathologies such as degenerative disc disease and spondylolisthesis.➤ The distribution of caudal lordosis (L4-S1) and cranial lordosis (L1-L4) as a percentage of global lordosis varies by pelvic incidence (PI), with cephalad lordosis increasing its contribution to total lordosis as PI increases.➤ Spinal fusion may lead to iatrogenic deformity if performed without attention to lordosis magnitude and location in the lumbar spine.➤ A solid foundation of knowledge with regard to optimal spinal sagittal alignment is beneficial when performing lumbar spinal surgery, and thoughtful planning and execution of lumbar fusions with a focus on alignment may improve patient outcomes.

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Sagittal spinopelvic alignment after spinal fusion in degenerative lumbar scoliosis: a meta-analysis

Cited by 7 publications

References 40 publications

Emerging Technologies within Spine Surgery

Emerging Technologies within Spine Surgery

Risk Factors of Postoperative Coronal Balance Transition in Degenerative Lumbar Scoliosis

Sagittal Alignment in the Degenerative Lumbar Spine

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