Simple prediction method of lumbar lordosis for planning of lumbar corrective surgery: radiological analysis in a Korean population

Lee, Chong Suh; Chung, Sung Soo; Park, Sejun; Kim, Dong Min; Shin, Seong Kee

doi:10.1007/s00586-013-2895-1

Cited by 37 publications

(26 citation statements)

References 36 publications

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“…The importance of maintenance or restoration of spinopelvic balance cannot be understated with numerous works demonstrating the correlation of quality of life measures with spinal parameters (Schwab et al, ; Takemoto et al, ; Kyrola et al, ; Protopsaltis et al, ). There are also numerous formulae to predict ideal lordosis on the basis of PI (Legaye and Duval‐Beaupere, ; Vialle et al, ; Rose et al, ; Schwab et al, ; Lee et al, ; Xu et al, ; Yamato et al, ).…”

Section: Introductionmentioning

confidence: 99%

Pelvic Incidence: Computed Tomography Study Evaluating Correlation with Sagittal Sacropelvic Parameters

2019

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Normal values for spinal alignment are often based on the pelvic incidence (PI), defined as the angle subtended by a line from the bicoxofemoral axis to the midpoint of the sacral endplate and a line perpendicular to the midpoint. Despite widespread use, determinants of its values remain obscure. The aim of this study was to determine correlation of sacropelvic parameters with the PI on computed tomography (CT). CT scans performed for trauma were identified over a 1-year period. Patients aged over 16 were included. PI, sacral anatomic orientation, sacral table angle (STA), sacral kyphosis (SK), pelvic thickness (PTH), femorosacral pelvic angle, pelvisacral angle, and sacropelvic angle were measured. Additional novel measures including crest-to-pubis distance, crest-to-sacrum distance (CSD), inlet distance, outlet distance, and inlet-outlet angle were taken. One hundred and seventy-seven scans were analyzed. Mean age 44.3 years; 62% male. The mean PI was 50.1 (SD 10.8; range 29-87). SK (r = 0.769), inlet-outlet angle (r = −0.533), PTH (r = −0.370), CSD (r = 0.290), and STA (r = −0.276) significantly correlated with PI. Multivariate analysis developed a predictive equation of: PI = 101.45 − (0.52 × STA) + (0.67 × SK) − (0.34 × inlet-outlet angle), with an adjusted R 2 0.734 (P < 0.001).Measures that represent the sacral morphology, particularly SK, and the position of the sacrum in space correlated strongly with the PI and contributed strongly to a predictive equation. These findings may direct further efforts to explore how the PI is determined and therefore how it may be modified. Clin. Anat. 33:237-244, 2020Rothenfluh et al., 2015;Pesenti et al., 2018). Many have described normative values for PI and subsequently related the normal spinal curvature, including lumbar lordosis and thoracic kyphosis, back to the

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Section: Introductionmentioning

confidence: 99%

Pelvic Incidence: Computed Tomography Study Evaluating Correlation with Sagittal Sacropelvic Parameters

2019

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“…Considering that one article reported an overcorrection of lumbar lordosis (LL) as an effective treatment modality to maintain optimal sagittal alignment in patients with degenerative lumbar kyphosis, it should be considered in preoperative planning for patients with adult spinal deformity and sagittal imbalance. 10 The primary goal of the surgical correction described in this study was to achieve an ideal LL, with a theoretical value calculated according to the Korean version of Legaye's formula (sacral slope [SS] = 0.80+0.74 pelvic incidence, lower LL = 5.20 +0.87 SS, maximal LL = 17.41+0.96 SS), as reported by Lee et al [10][11][12] In our case study, according to this formula, the highest and lowest LL in the patient were -57.97° and -41.94°, respectively. Therefore, in the first operation performed on our patient, Fig.…”

Section: Discussionmentioning

confidence: 90%

Rod Fracture Causing Relief of Back Pain That Developed After Adult Lumbar Degenerative Flat-Back Correction Surgery: A Case Report

Choi¹,

Jang²,

Jang

2019

Neurospine

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A 73-year-old woman underwent deformity correction surgery (anterior lumbar interbody fusion of L2-L3-L4-L5-S1, pedicle subtraction osteotomy at L4, and posterior screw fixation from T10 to the pelvis) due to lumbar degenerative flat-back. Following the operation, the patient experienced pain in her back and buttocks, for which she regularly took medications. She reported frequently feeling a heavy and stretched sensation of pain after the operation in those areas, which made her regret undergoing the operation. However, at 33 months postoperatively, she reported that one day, while getting up from a chair, she felt a crack in her back, which was followed by an improvement in her back and buttock pain; thereafter, she stopped taking pain medications. Follow-up radiography revealed a bilateral rod fracture at the L4-5 level on the right side and at the L3-4 level on the left side. The overall pelvic parameters, except pelvic incidence, slightly changed after the rod fracture. Therefore, the broken rod was replaced and another rod was added to the broken rod area; however, the changed pelvic parameters were not corrected further during the reoperation. Following the reoperation, the patient showed improvements and she no longer required pain medication.

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“…Several formulas have been created to evaluate the ideal LL to be reestablished in lumbar fusion surgery in different populations. Based on Legaye's formula in Korean patients [18] , Lee et al [9] found that overcorrection of LL (postoperative LL angle > ideal LL) effectively maintains the optimal SVA in patients with degenerative lumbar kyphosis during a minimum 2-year follow-up. Considering the effect of age, Xu et al [19] determined the predictive formula for the ideal LL in Chinese adults as: LL = 0.508 × PI -0.088 × age + 28.6.…”

Section: Discussionmentioning

confidence: 99%

Estimation of the Ideal Correction of Lumbar Lordosis to Prevent Reoperation for Symptomatic Adjacent Segment Disease After Lumbar Fusion in Older People

Wang

Zhang

et al. 2020

Preprint

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Abstract Background Symptomatic adjacent segment disease (ASDis) is a major complication following spinal fusion. Sagittal spinopelvic imbalance may contribute to the development of ASDis. However, the exact ideal correction of LL is unknown for different ages of people to prevent ASDis. The purpose of this study was to estimate the ideal correction of lumbar lordosis (LL) required to prevent symptomatic ASDis requiring revision surgery in patients of various ages, and to determine the radiographic risk factors for ASDis.Methods 468 patients who underwent lumbar fusion between January 2014 and December 2016, were enrolled in the present study. The patients were classified into the ASDis and N-ASD group. These two matched groups were compared regarding surgery-related factors and radiographic features. Multivariate logistic regression analysis was used to evaluate the risk factors for ASDis.Results Sixty-two patients (13.25%) underwent reoperation for ASDis during a mean follow-up duration of 38.07 months. Receiver operating characteristic curve analysis showed that the postoperative LL - preoperative LL (△LL) cutoff value was 11.7°for the development of ASDis. Logistic regression analysis revealed that the risk factors for symptomatic ASDis were a smaller LL angle, △LL > 12°, and PI-LL > 10° (p < 0.05). For patients > 60 years, the incidence of ASDis was higher in patients with a LL correction of ≥ 10° and a lumbar-pelvic mismatch (PI-LL) of > 20°.Conclusions The significant predictors of the occurrence of ASD were a smaller LL angle, △LL > 12°, and PI-LL > 10°. However, in patients older than 60 years, the incidence of ASD after lumbar fusion was higher in those with a LL correction of ≥ 10° and PI-LL of > 20°. More attention should be paid to patient age and the angle of correction of LL before lumbar fusion.

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Simple prediction method of lumbar lordosis for planning of lumbar corrective surgery: radiological analysis in a Korean population

Abstract: This simple calculation method can provide a more appropriate and simpler prediction of lumbar lordosis for Asian populations. The prediction of lumbar lordosis should be used as a reference for surgeons planning to restore the lumbar lordosis in lumbar corrective surgery.

Cited by 37 publications

References 36 publications

Pelvic Incidence: Computed Tomography Study Evaluating Correlation with Sagittal Sacropelvic Parameters

Pelvic Incidence: Computed Tomography Study Evaluating Correlation with Sagittal Sacropelvic Parameters

Rod Fracture Causing Relief of Back Pain That Developed After Adult Lumbar Degenerative Flat-Back Correction Surgery: A Case Report

Estimation of the Ideal Correction of Lumbar Lordosis to Prevent Reoperation for Symptomatic Adjacent Segment Disease After Lumbar Fusion in Older People

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