The cranial sagittal vertical axis (CrSVA) is a better radiographic measure to predict clinical outcomes in adult spinal deformity surgery than the C7 SVA: a monocentric study

Kim, Yongchan; Lenke, Lawrence G.; Lee, Seon-Jong; Gum, Jeffrey L.; Wilartratsami, Sirichai; Blanke, Kathy

doi:10.1007/s00586-016-4757-0

Cited by 36 publications

(34 citation statements)

References 24 publications

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“…Understanding sagittal balance provides the most appropriate choice [52]. Sagittal balance is a dynamic phenomenon, and it is better to have a good sagittal balance (even compensated) than a good sagittal alignment with a long fusion and no ability to compensate [39,53]. This is the reason why we came to the conclusion that the recent papers providing rules to tolerate increased pelvic tilt and SVA in elderly is probably not appropriate.…”

Section: Clinical Applicationmentioning

confidence: 99%

Sagittal balance of the spine

et al. 2019

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The static sagittal balance of the normal spine is a physiological alignment of the spine in the most efficient manner by the muscular forces. During gait, this balance is constantly thwarted by single-foot support. This analysis involves the study of parameters which are now well defined. The pelvic incidence is constant, and the sacral slope and the pelvic tilt are positional. The cervical parameters are the upper (O-C2) and lower cervical curvatures (C2-C7), the C7 slope, the spinocranial angle and the vertical cervical offset. At the thoracic and lumbar level, they are, respectively, kyphosis and lordosis. The OD-HA (odontoid hip axis) angle is the most efficient parameter to analyse the global balance. The average values of these parameters are reported with the new 3D measurements by Le Huec et al. The relationship between these different parameters was analysed, and Roussouly proposed his classification of the different spine shape. Ageing makes it possible to show compensation mechanisms at three levels: spinal, pelvic and lower limbs. Understanding these different data allows for better planning of the surgical management of the patients. Global evaluation of the entire spine and the measurement of the aforementioned parameters allow to determine the extent of the correction to be performed during surgery. Taking these parameters into account also enables us to understand the complications involved in this type of surgery: transitional syndromes or junctional syndromes. Integration of these parameters into the study of gait is an area still under investigation.

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Section: Clinical Applicationmentioning

confidence: 99%

Sagittal balance of the spine

et al. 2019

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“…But we found no signi cant differences between the preoperative value and the ultimate follow-up value in CrSVA-S and CrSVA-H, which means C7SVA is less sensitive than CrSVA-S and CrSVA-H in detecting mild deterioration of global sagittal balance. It was also reported CrSVA was more correlated with ODI and all SRS subscores than C7SVA [7], which could not consider the motion of cervical spine[21]. But we still think further investigation of cranial parameters is warranted to clarify their meaning as global alignment parameters.…”

Section: Discussionmentioning

confidence: 99%

“…The radiographic parameters included (1) C7 sagittal vertical axis(C7SVA); the distance between the vertical plumb line centered in the middle of C7 vertebral body and the posterosuperior corner of S1, (2) Cranial-sagittal vertical axis-hip(CrSVA-H); the distance between the vertical plumb line from the cranial center of gravity(CCG) to the centers of femoral heads [7], (3) Cranial-sagittal vertical axis-Sacrum(CrSVA-S); the distance between the vertical plumb line from the CCG to the posterosuperior corner of S1 [7], (4) Cervical lordosis(CL); the angle created by a line parallel to the inferior endplate of C2 and a line parallel to the inferior endplate of C7, (5) Thoracic kyphosis(TK); the angle created by a line parallel to the inferior endplate of T5 and a line parallel to the inferior endplate of T12, (6) Thoracolumbar kyphosis(TLK); the angle created by a line parallel to the superior endplate of T10 and a line parallel to the inferior endplate of L2, (7) Lumbar lordosis(LL); the angle created by a line parallel to the superior endplate of L1 and a line parallel to the endplate of S1, (8) Pelvic tilt(PT); the angle between the vertical line connecting the midpoint of the sacral plate to the femoral head axis and the vertical axis. For all sagittal measurements, the angle was de ned to be negative if the curve was lordotic and positive if the curve was kyphotic.…”

Section: ) Radiographic Assessmentmentioning

confidence: 99%

“…The methods used for measurement of parameters representing sagittal vertical axis (C7SVA, CrSVA-H and CrSVA-S) are shown in Fig.1.and 2. [7] The CCG was de ned as a point approximately 1 cm above and anterior to the external auditory canal, which was nearly equal to the midpoints of the nasion-inion line (root of the nose to the outer cortex of the external occipital protuberance) [8]. All radiographic parameters were measured by PiViewSTAR Software.…”

Section: ) Radiographic Assessmentmentioning

confidence: 99%

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Radiographic and Clinical Evidence: Osteoarthritic Knee Can Change Surgical Result for Lumbar Degenerative Disease Patient Undergone Surgery for 3-year Follow-up: A Retrospective Comparative Clinical Study

Kim

et al. 2020

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Background: There is a paucity of reports clarifying the implication of knee osteoarthritis (OA) on spinal sagittal alignment of patients undergone surgery for lumbar spine. This study aimed to analyze how osteoarthritic knee affects radiographic and clinical results of degenerative lumbar disease patients undergone lumbar fusion.Methods: We retrospectively reviewed the medical records and radiographs of 74 consecutive degenerative lumbar disease patients who underwent posterior instrumentation and fusion surgery between May 2016 and June 2017 and were followed up for minimum 3 years postoperatively. The patients were divided into 2 groups according to the severity of knee OA by Kellgren-Lawrence grading (KLG) scale (group I, KLG 1 or 2 [n=39]; group II, KLG 3 or 4 [n=35]). Patient demographic data, comorbidities, spinal sagittal parameters and clinical scores were extracted and compared at preoperative, postoperative 1 month and the ultimate follow-up between the groups. In radiographic assessment, sagittal alignment parameters and sagittal balance were used. In clinical assessment, the scores of Oswestry disability index (ODI) and Scoliosis Research Society questionnaire (SRS-22) were used. For the frequency analysis of categorical variables across the groups, chi-square test was used and student t tests was used to assess the differences of continuous variables.Results: In radiographic assessment, TLK(thoracolumbar kyphosis), LL(lumbar lordosis), PT(pelvic tilt), C7 SVA(sagittal vertical axis) in both groups improved significantly after surgery(p<0.05). However, LL, PT, C7SVA improved at postoperative 1 month in the group II were not maintained at the ultimate postoperative follow-up. In clinical assessment, preoperative Oswestry disability index (ODI, %) and all SRS-22 subscores of the group I and II were not different (p>0.05). There were significant differences between the groups at the ultimate follow-up in ODI (-25.6 vs -12.1, p<0.001), SRS total score (%) (28 vs 20, p=0.037), function subscore (1.4 vs 0.7, p=0.016), and satisfaction subscore (1.6 vs 0.6, p<0.001).Conclusion: Osteoarthritic knee with KLG 3 or 4 have a negative influence on maintaining postoperative spinal sagittal alignment, balance, and the clinical outcomes achieved immediately by posterior instrumentation and fusion for lumbar degenerative disease.Trial registration: This study was retrospectively registered with approval by the institutional review board(IRB) of our institution(approval number: 2018-11-007).

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“…Several studies have already demonstrated that the improvement in sagittal balance using the C7 SVA is the strongest predictor of improved outcomes in patients with adult spinal deformity [3][4][5][6], but Kim et al considered the cranial sagittal vertical axis (CSVA) is a better radiographic measure to predict clinical outcomes in adult spinal deformity surgery than C7 SVA [7].…”

Section: Introductionmentioning

confidence: 99%

The difference of whole-body sagittal alignment in different postures in young, healthy adults

Xue

Shen²,

Dai³

2020

Preprint

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Study DesignProspective study.ObjectiveTo identify the differences of radiographic between standard upright position and natural and comfortable upright position.MethodsRadiographic parameters of 50 young and healthy adults were evaluated including the global cervical angle (GCA), global thoracic angle (GTA), global lumbar angle (GLA), which were used to depict the spine profile; the distance from the cranial sagittal vertical axis (CSVA) to the posterior corner of S1(CSVA-S), the center of the hip(CSVA-H), the center of the knee(CSVA-K) and the ankle(CSVA-A), respectively in both upright positions and natural and comfortable upright position, which were employed to describe the whole-body balance.ResultsSignificant differences could be observed in all the GCA(17.39 ± 6.90 vs. 10.90 ± 3.77, p < .001), GTA(25.63 ± 7.27 vs. 45.42 ± 8.15 p < .001), GLA(42.64 ± 8.05 vs. 20.21 ± 7.47 p < .001), CSVA-S(0.33 ± 2.76 cm vs. 8.54 ± 3.78 cm, p < 0.001), CSVA-H(1.53 ± 3.11 cm vs. 5.71 ± 3.26 cm, p < 0.001), CSVA-K(3.58 ± 2.47 cm vs. 5.22 ± 2.69 cm, p = 0.002) and CSVA-A(1.79 ± 1.92 cm vs. 4.79 ± 2.51 cm, p < 0.001) in the two different standing postures, respectively. Compared with standard upright position, natural and comfortable upright position results in a more kyphotic spine profile.ConclusionSignificant differences in sagittal radiographic parameters were found between the standard upright position and natural and comfortable upright position, with the latter revealing a more kyphotic spinal profile more common in everyday life, which may explain the existing spinal pathologies as well as predict postoperative complications. The natural and comfortable upright position should be a factor to consider when performing a surgical plan.

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The cranial sagittal vertical axis (CrSVA) is a better radiographic measure to predict clinical outcomes in adult spinal deformity surgery than the C7 SVA: a monocentric study

Cited by 36 publications

References 24 publications

Sagittal balance of the spine

Sagittal balance of the spine

Radiographic and Clinical Evidence: Osteoarthritic Knee Can Change Surgical Result for Lumbar Degenerative Disease Patient Undergone Surgery for 3-year Follow-up: A Retrospective Comparative Clinical Study

The difference of whole-body sagittal alignment in different postures in young, healthy adults

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