Surgical Outcomes of Post-Fusion Lumbar Flatback Deformity with Sagittal Imbalance

Kim, Jin-Seong; Kim, Sung Min

doi:10.3340/jkns.2016.59.6.615

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…It is noteworthy that the subscale of self-image was improved the most, whereas functional category the least, in the present study. These findings are also consistent with most previous literatures 11,22,23) , possibly reflecting the double sidedness of the deformity correction surgery including long level instrumentation.…”

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confidence: 93%

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

Choi

Hyun

Kim

et al. 2020

J Korean Neurosurg Soc

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The purpose of this study was to report the results of pedicle subtraction osteotomy (PSO) for fixed sagittal imbalance with a minimum 2-year follow-up. Besides, authors evaluated the effect of adjunctive multi-level posterior column osteotomy (PCO) on achievement of additional lumbar lordosis (LL) during PSO. Methods : A total of 31 consecutive patients undergoing PSO for fixed sagittal imbalance were enrolled and analyzed. Correction angle of osteotomized vertebra (PSO angle) and other radiographic parameters including pelvic incidence (PI), thoracic kyphosis, LL, and sagittal vertical axis (SVA) were evaluated. Clinical outcomes and surgical complications were also assessed. Results : The mean age was 66.0±9.3 years with a mean follow-up period of 33.2±10.5 months. The mean number of fused segments was 9.6±3.5. The mean operative time and surgical bleeding were 475.9±160.5 minutes and 1406.1±932.1 mL, respectively. The preoperative SRS-22 score was 2.3±0.7 and improved to 3.2±0.8 at the final follow-up. The mean PI was 54.5±9.5°. LL was changed from 7.0±28.9° to-50.2±13.2°. The PSO angle was 33.7±13.5° (15.6±20.1° preoperatively,-16.1±19.4° postoperatively). The difference of correction angle of LL (57.3°) was greater about 23.6° than which of PSO angle (33.7°). SVA was improved from 189.5±93.0 mm, preoperatively to 12.4±40.8 mm, postoperatively. There occurred six, eight, and 14 cases of complications at intraoperative, early (<2 weeks) postoperative, and late (≥2 weeks) postoperative period, respectively. Additional operations were needed in nine patients due to the complications. Conclusion : PSO could provide satisfactory results for patients with fixed sagittal imbalance regarding clinical and radiographic outcomes. Additional correction of LL could be achieved with conduction of adjunctive multi-level PCOs during PSO.

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confidence: 93%

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

Choi

Hyun

Kim

et al. 2020

J Korean Neurosurg Soc

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“…Simon et al found that less lordosis was associated with better quality of life because these patients also had a lower pelvic incidence and therefore better sagittal balance (27). In a Korean study, patients with SVA >5 cm showed a significant improvement in clinical outcome (17). Ploumis et al demonstrated that there was no significant difference between patients with sagittal plane plumbline offset ≥50 mm and those with offset <50 mm with respect to Oswestry and Roland-Morris scores (24).…”

Section: █ Discussionmentioning

confidence: 99%

The effect of distal fusion level on functional and radiographic parameters following long posterior instrumentation and fusion

Olguner

Çeliktaş²,

Arslan³

et al. 2020

Turkish Neurosurgery

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AIM:To investigate the effect of distal fusion level on radiographic parameters and functional outcome in patients with degenerative spine disease who undergo long posterior fusion with instrumentation. MATERIAL and METHODS:This study included 78 adult patients aged>60 years who underwent long posterior fusion (>6 levels) for spinal deformity with a minimum 2-year follow-up. The patients were divided into two groups based on distal fusion level (L5 group and iliac group). Spinopelvic parameters, including lumbar lordosis (LL) and sagittal vertical axis (SVA), were evaluated. Functional outcome was evaluated with the pain visual analog scale (VAS) and the Oswestry Disability Index (ODI) questionnaire. Correlations between clinical and radiographic parameters were calculated statistically. RESULTS:In the L5 group, the mean SVA and LL significantly improved after surgery (p=0.025 and 0.008, respectively). Similarly, the SVA and LL also improved significantly in the iliac group (p=0.002 and 0.001, respectively). In both groups, lumbar VAS, leg VAS and ODI scores significantly improved (p<0.001). The change in ODI score was significantly greater in the iliac group than the L5 group (p=0.013). CONCLUSION:Although patients did not achieve the desired optimal spinal saggital balance, both L5 and iliac groups showed significant improvement in VAS and ODI scores. The iliac group showed slightly better improvement in ODI score.

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“…Furthermore, the PI-LL mismatch (LG) after longsegment fusion surgery, particularly for ASD, was found to be associated with residual postoperative symptoms such as low back pain (LBP), lower extremity pain, and numbness [12]. Numerous studies demonstrated a strong correlation between the improvement of sagittal deviation and clinical outcomes after instrumented fusion for various degenerative lumbar spine diseases [11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Long-term impact of sagittal malalignment on hardware after posterior fixation of the thoracolumbar spine: a retrospective study

Elshamly

Windhager

Toegel

et al. 2020

BMC Musculoskelet Disord

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Background: The importance of sagittal alignment in healthy individuals and in reconstructive spinal surgery has been studied over the last 15 years. The aim of the present study was to assess the long-term effects of abnormal sagittal alignment on hardware after posterior thoracolumbar spinal fusion. Methods: Patients who had undergone revision surgery (revision cohort, n = 34) due to breakage of their implants were compared retrospectively with patients who had intact implants at the final follow-up investigation after a long posterior thoracolumbar and/or lumbar spinal fusion (control cohort, n = 22). Clinical data and radiological parameters including the sagittal vertical axis (SVA), pelvic incidence (PI), lordosis gap (LG), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and the femoral obliquity angle (FOA) were assessed on fullspine lateral radiographs obtained in regular standing position. Data were analysed using descriptive statistics, parametric and non-parametric inferential statistics. Results: Patients in the breakage group (female n = 21, male n = 9, mean age 60.9 ± 15.6 years) had a higher anterior shift of the C7 plumb line (SVA) (p = 0.02), retroversion of the pelvis (PT) (p < 0.001), PILL mismatch (LG) (p = 0.001), and PI (p = 0.002) than the intact group (female n = 10, male n = 12, mean age 65.7 ± 12.4 years). No significant difference was registered between groups in regard of SS, LL, TK, FOA, and the mean number of comorbidities. Conclusion: Failure of restoration of the SVA and the LG to the acceptable ranges, especially in patients with a high PI, may be regarded as a risk factor for the long-term failure of implants after posterior thoracolumbar spinal fusion.

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Surgical Outcomes of Post-Fusion Lumbar Flatback Deformity with Sagittal Imbalance

Cited by 4 publications

References 19 publications

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

The effect of distal fusion level on functional and radiographic parameters following long posterior instrumentation and fusion

Long-term impact of sagittal malalignment on hardware after posterior fixation of the thoracolumbar spine: a retrospective study

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