Surgical treatment of thoraco-lumbar kyphosis (TLK) associated with low pelvic incidence

Scemama, Caroline; Laouissat, Féthi; Abelin-Genevois, Kariman; Roussouly, Pierre

doi:10.1007/s00586-017-4984-z

Cited by 17 publications

(17 citation statements)

References 21 publications

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“…Roughly, a preoperative flat back (type 2) has to stay flat. On the other hand, a pre-existing thoracic kyphosis is better to be reduced in type 1, extending the kyphosis in thoraco-lumbar area as was shown by Scemama et al [20]. In any case, increasing lordosis in length and angle and thus turning the spinal shape into an anteverted type 3 is a bad option and results in high rates of PJK [20,21].…”

Section: Discussionmentioning

confidence: 93%

“…In summary, the PI value of the initial shape is poorly affected by the degeneration with small balance compensation and thus maintaining the shape is quite easy and always a good option. Type 1 remains problematic for the majority of spine surgeons because reducing the thoracolumbar kyphosis is a common belief that generally leads to complications by inducing an anteverted type 3 that is always a bad option [20]. In the cases where there are compensatory mechanisms, the initial shape has therefore changed.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

et al. 2019

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Purpose To evaluate the incidence of mechanical complications in patients with adult spine deformity (ASD) treated by restoring the normal shape according to the Roussouly classification. Methods This is a retrospective multicentric study with a minimum follow-up of 2 years. Patients operated on with fusion for ASD (minimum performed fusion: L2 to sacrum) were included. Patients with a history of previous spinal fusion of more than three levels were excluded. Spinal and pelvic parameters were measured on the preoperative and the immediate postoperative follow-up. All mechanical complications were recorded. Results A total of 290 patients met the criteria of inclusion with a minimum follow-up of 2 years. Mechanical complications occurred in 30.4% of the cohort. The most common complication was PJK with an incidence of 18% while nonunion or instrumentation failure (rod breakage, implant failure) occurred in 12.4%. 66% of the patients were restored to the normal shape according to the Roussouly classification based on their PI and had a mechanical complication rate of 22.5%, whereas the remaining 34% of patients had a complication rate of 46.8% (p < 0.001). The relative risk for developing a mechanical complication if the algorithm was not met was 3 (CI 1.5-4.3; p < 0.001) Conclusion In the recent literature, there are no clear guidelines for ASD correction. Restoring the sagittal spinal contour to the normal shapes of Roussouly according to the PI could serve as a guideline for ASD treatment. Ignoring this algorithm has a threefold risk of increased mechanical complications. We recommend this algorithm for treatment of ASD. Level of evidence IV cross-sectional observational study. Graphic abstractThese slides can be retrieved under Electronic Supplementary Material. Sebaaly AY, Gehrchen M, Silvestre C, Kharrat KE, Bari TJ, Kreichati G, Rizkallah M, Roussouly P (2019) Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study. Eur Spine J;

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

et al. 2019

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“…As it is a unique value for each patient, it allows determination of the type of sagittal profile according to Roussouly, making it possible, in cases where it is altered by degenerative pathology, to identify the ‘theoretical sagittal shape’ of the patient, guiding where and how much lordosis is necessary to restore with surgery in order to match this theoretical form, 43 which could lead to better functional results and fewer mechanical complications. 11 , 21 , 44 – 47 As Roussouly states, ‘in case of pathology, the PI is the only signature we have to determine the original shape of the spine and restore the balance of the patient’. 21 …”

Section: From Theory To Practicementioning

confidence: 99%

Sagittal balance: from theory to clinical practice

et al. 2021

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Adequate sagittal balance (SB) is essential to maintain an upright, efficient, and painless posture. It has been shown that sagittal profile alterations affect quality of life of patients with a similar or even greater impact than chronic disease. Evaluation of the SB has gained much relevance in recent years, with recognition of its importance in the evaluation of spinal pathology. This review summarizes the basic principles of SB, aiming to obtain a practical, simple and understandable evaluation of the sagittal profile of a patient. SB is a dynamic process that involves a varying degree of energy expenditure. Distinguishing between a balanced, compensated imbalance or decompensated imbalanced patient, is relevant to diagnosis and therapeutic decision-making. Cite this article: EFORT Open Rev 2021;6:1193-1202. DOI: 10.1302/2058-5241.6.210062

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“…As a result, the Roussouly classification has become one of the most widely used classification systems since 2005, when it was first reported. Many studies have proven the effects of the classification system on surgical decisions and outcomes [9,10,11] . In addition, studies have assessed the correlation between the morbidity of spine disorders and different Roussouly types.…”

Section: The Roussouly Classification Is Based On Features Of Spine Mmentioning

confidence: 99%

The characteristics of lumbar paraspinal muscle degeneration based on the Roussouly classification: a retrospective study

Yang

Zou

et al. 2020

Preprint

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Background: To analyse the characteristics of lumbar paraspinal muscle degeneration in individuals with different Roussouly types.Methods: Eighty patients (20 patients for each Roussouly type) with degenerative lumbar disease were retrospectively enrolled from January 2017 to February 2018. The cross-sectional area (CSA) and percentage of fat infiltration (FI) of the paraspinal muscles at the L1-S1 levels were measured using T2-weighted axial MRI and ImageJ software. The measured data were analysed with independent samples t-tests.Results: Degeneration of the paraspinal muscles of the upper lumbar region was significantly severer in Type 1 than in Type 3, the degrees of paraspinal muscle degeneration of Type 2 appeared to be more evenly distributed in all segments than Type 3, and Type 4 showed severer degeneration in L5-S1 than Type 3.Conclusion: The degree of paraspinal muscle degeneration in each segment was different across the four Roussouly types, but the degrees of degeneration were consistent with the characteristics of degenerative disease within each type.

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Surgical treatment of thoraco-lumbar kyphosis (TLK) associated with low pelvic incidence

Cited by 17 publications

References 21 publications

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

Mechanical complications in adult spinal deformity and the effect of restoring the spinal shapes according to the Roussouly classification: a multicentric study

Sagittal balance: from theory to clinical practice

The characteristics of lumbar paraspinal muscle degeneration based on the Roussouly classification: a retrospective study

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