Orientation of L4 coronal tilt relative to C7 plumb line as a predictor for postoperative coronal imbalance in patients with degenerative lumbar scoliosis

Abstract The study design is case–control. To evaluate the impact of preoperative coronal patterns based on the relationship between orientation of L4 coronal tilt and C7 plumb line on immediate postoperative coronal imbalance in degenerative lumbar scoliosis (DLS) patients. Although lumbosacral fractional curve has been long stressed in correction surgery of DLS, there is paucity of literature focusing on preoperative coronal pattern based on the relationship between orientation of L4 coronal tilt and C7 plumb line and its impact on immediate postoperative coronal imbalance in DLS patients. A consecutive series of DLS patients who underwent deformity correction surgery via posterior-only approach were reviewed. According to the relationship between orientation of L4 coronal tilt and C7 plumb line preoperatively, a total of 77 DLS patients who underwent posterior spinal corrective surgery were classified into: 1. Coronal consistency pattern, L4 coronally tilts toward C7 plumb line; 2. Coronal opposition pattern, L4 coronally tilts opposite C7 plumb line. Coronal imbalance was defined as global coronal malalignment (GCM) on either side more than or equal to 20 mm. Whole-spine standing radiographs of both pattern groups were assessed preoperatively and postoperatively. There were 37 patients with coronal consistency pattern and 40 patients with coronal opposition pattern. Compared to patients with coronal opposition pattern, patients with coronal consistency pattern had significantly higher postoperative GCM (P = 0.028), lower amount of GCM correction (P = 0.013) and higher incidence of postoperative coronal imbalance (P = 0.001); further logistic regression analysis revealed coronal consistency pattern was associated with increased odds of postoperative coronal imbalance (odds ratio: 5.981; 95% confidence interval 2.029–17.633; P = 0.001). DLS patients with preoperative coronal consistency pattern carried greater risk for immediate postoperative coronal imbalance following posterior long correction surgery. Level of evidence 3

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Risk Factors for Immediate Postoperative Coronal Imbalance in Degenerative Lumbar Scoliosis Patients Fused to Pelvis

Global Spine Journal ◽

10.1177/2192568220917648 ◽

2020 ◽

pp. 219256822091764

Author(s):

Jiandang Zhang ◽

Zheng Wang ◽

Pengfei Chi

Keyword(s):

Risk Factors ◽

Cobb Angle ◽

Deformity Correction ◽

Lower Amount ◽

Degenerative Lumbar Scoliosis ◽

Retrospective Case ◽

Lumbar Scoliosis ◽

Coronal Imbalance ◽

Type C ◽

Upper Instrumented Vertebra

Study Design: Retrospective case-control radiographic study. Objective: To identify risk factors for immediate postoperative coronal imbalance in degenerative lumbar scoliosis (DLS) patients fused to pelvis. Methods: A total of 71 DLS patients treated with deformity correction surgery were reviewed. Measurements included coronal parameters such as global coronal malalignment (GCM), major Cobb angle, L4/L5 coronal tilt and sagittal parameters. Based on the orientation of L4 coronal tilt relative to C7 plumb line (PL) preoperatively, coronal patterns were subdivided into (1) consistency pattern, L4 coronally tilts toward C7 PL, and (2) opposition pattern, L4 coronally tilts opposite C7 PL; the proportion of these 2 patterns was analyzed. Also, the proportion of type C and surgical factors were recorded. According to postoperative GCM, patients were divided into imbalanced group and balanced group. Results: Compared with the balanced group, the imbalanced group had a larger proportion of preoperative consistency pattern (79.17% vs 40.43%, P = .002), larger proportion of type C (29.17% vs 8.51%, P = .023), and lower amount of GCM correction (−4.92 ± 24.25 vs 14.52 ± 19.49 mm, P < .001). There were no significant intergroup differences regarding preoperative and postoperative major Cobb angle, preoperative and postoperative L4 or L5 coronal tilt, major Cobb correction, the amounts of correction of coronal tilt of L4/L5, osteotomy levels, osteotomy grades, instrumented levels, levels of interbody fusion, and distribution of upper instrumented vertebra. Conclusions: In addition to known risk factors such as type C, preoperative coronal consistency pattern might be a new risk factor for postoperative coronal imbalance in DLS patients fused to pelvis.

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Directionality of Lumbosacral Fractional Curve Relative to C7 Plumb Line, A Novel Index Associated With Postoperative Coronal Imbalance in Patients With Degenerative Lumbar Scoliosis

Spine ◽

10.1097/brs.0000000000003776 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Jiandang Zhang ◽

Zheng Wang ◽

Pengfei Chi ◽

Cheng Chi

Keyword(s):

Plumb Line ◽

Degenerative Lumbar Scoliosis ◽

Lumbar Scoliosis ◽

Coronal Imbalance

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Evaluation of Lumbar Stiffness after Long-Level Fusion for Degenerative Lumbar Scoliosis in Chinese population

10.21203/rs.3.rs-24904/v2 ◽

2020 ◽

Author(s):

Xinling Zhang ◽

Lei Yuan ◽

Yan Zeng ◽

Zhongqiang Chen ◽

Weishi Li ◽

...

Keyword(s):

Internal Consistency ◽

Chinese Population ◽

Chinese Patients ◽

Personal Hygiene ◽

Degenerative Lumbar Scoliosis ◽

Lumbar Scoliosis ◽

Patient Reported ◽

Elderly Chinese ◽

The Impact ◽

Level Fusion

Abstract Study Design: a retrospective study.Summary of Background Data: Long-level spinal instrumented fusion for DLS by intention eliminated spinal motion in an attempt to alleviate pain, improve deformity, and reduce disability. However, this surgery considerably impaired performance of activities of daily living (ADL) due to the resulting stiffness. The lumbar stiffness disability index (LSDI) was a validated measure of the effect of lumbar stiffness on functional activity, however, which might not be fully applicable to elderly Chinese population because of their several special lifestyles.Objective: To evaluate the lumbar stiffness in patients with degenerative lumbar scoliosis (DLS) after long-level fusion by Chinese-LSDI (C-LSDI).Methods: 129 DLS patients underwent long-level (≧4 levels) fusion surgery with at least one-year follow-up were included. The C-LSDI was designed by modifying LSDI and Korean-LSDI (K-LSDI) considering elderly Chinese lifestyles, and the patient-reported outcome questionnaire measuring the impact of lumbar stiffness on functional abilities in elderly Chinese with DLS was assessed for internal consistency and retest repeatability.Results: All patients showed increased lumbar stiffness with significantly improvement in pain and deformity postoperatively, and for items of performing personal hygiene after toileting and getting out of a car, people performed more inconvenient with increasing fixed levels. Compared with LSDI and K-LSDI, the C-LSDI demonstrated high internal consistency (Cronbach’s alpha=0.902) and retest reliability (ICC=0.904) in the elderly Chinese population. Conclusion: This study demonstrated that the C-LSDI questionnaire was a reliable and valid instrument for assessing functional limitations due to lumbar stiffness among elderly Chinese patients with DLS after long-level fusion. Although the effects of stiffness did trend toward greater impacts among patients underwent longer fusions, most patients were satisfied with trade-offs of function and pain relief in exchange for perceived increases in lumbar stiffness.

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CHALLENGING DEGENERATIVE LUMBAR SCOLIOSIS WITH SEGMENTAL CORRECTIVE FUSION SURGERY

Journal of Musculoskeletal Research ◽

10.1142/s0218957706001807 ◽

2006 ◽

Vol 10 (03) ◽

pp. 141-150 ◽

Cited By ~ 1

Author(s):

Takahiro Iizuka ◽

S. Yamada

Keyword(s):

Spinal Curvature ◽

Degenerative Lumbar Scoliosis ◽

Spinal Alignment ◽

Poor Bone Quality ◽

Fusion Surgery ◽

Lumbar Scoliosis ◽

Cobb’S Angle ◽

Correction Surgery ◽

The Mean

Changes in the curvature have not been reported in degenerative lumbar scoliosis (DLS) when the correction surgery was performed. The purpose of our study was to clarify the influence of the correction surgery of DLS. Twenty-one patients underwent corrective lumbar reconstruction surgery (1998–2003) only at the neurologically affected levels. The spinal curvature was retrospectively evaluated in these 21 patients with DLS using Cobb's methods. The mean preoperative Cobb's angle was 17.7° while the mean postoperative Cobb's angle was 6.1° (p < 0.0001) at 1 month after the surgery and 9.0° at the final follow-up. The correction rate was 65.2% at 1 month after the surgery and 50.2% at the final follow-up. Cobb's angle increased by 2.9°/43.4 months (mean, 0.80°/year) in these procedure. The surgical goals of DLS are the relief of neurological disorders and the cessation of the deterioration of spinal alignment. Strategies for DLS may include complete decompression, or correction of the spinal alignment in elderly patients with poor bone quality. Decompression and correction in the PLIF procedure only at neurologically affected levels may be one of the surgical procedures to challenge DLS.

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Sequential correction using satellite rod for severe thoracic idiopathic scoliosis: an effective method to optimize deformity correction

Journal of Neurosurgery Spine ◽

10.3171/2020.9.spine201168 ◽

2021 ◽

pp. 1-7

Author(s):

Yang Li ◽

Benlong Shi ◽

Dun Liu ◽

Zhen Liu ◽

Xu Sun ◽

...

Keyword(s):

Blood Loss ◽

Idiopathic Scoliosis ◽

Deformity Correction ◽

Operation Time ◽

Consecutive Series ◽

Radiographic Parameters ◽

Significant Difference ◽

Correction Surgery ◽

Thoracic Idiopathic Scoliosis

OBJECTIVE The aim of this paper was to compare the radiographic and clinical outcomes between the sequential correction (SC) technique and the traditional 2-rod correction (TC) technique in patients with severe thoracic idiopathic scoliosis (STIS) undergoing posterior-only correction surgery. METHODS Records of a consecutive series of STIS patients undergoing posterior-only correction surgery between October 2013 and October 2017 with more than 2 years of follow-up were reviewed. The radiographic parameters were assessed preoperatively, postoperatively, and at the last follow-up. Radiographic parameters, operative time, blood loss, and complications were compared between the two groups. RESULTS A total of 33 patients were included in the SC group, and 21 patients were included in the TC group. There was no significant difference in age, sex, or deformity magnitude (93.6° ± 7.8° vs 89.8° ± 6.6°, p = 0.070) preoperatively between groups. The operation time was shorter in the SC group than in the TC group (251.5 ± 42.8 minutes vs 275.4 ± 39.8 minutes, p = 0.020), while both blood loss (1284.6 ± 483.3 vs 1398.0 ± 558.4 ml, p = 0.432) and number of fused levels (13.1 ± 2.8 vs 13.6 ± 2.4, p = 0.503) were similar between the groups. Compared with the TC group, patients in the SC group had a higher correction rate (55.8% ± 9.2% vs 45.7% ± 8.8%, p < 0.001), less coronal (1.1° ± 0.81° vs 2.9° ± 0.93°, p < 0.001) and sagittal (1.5° ± 0.96° vs 2.1° ± 0.64°, p = 0.015) correction loss at the 2-year follow-up, and a lower incidence of intraoperative pedicle screw pullout (14.3% vs 23.8%, p = 0.026). CONCLUSIONS The SC technique could significantly and practically reduce the difficulty of rod installation with better deformity correction outcomes than the traditional TC technique. The SC technique was an effective alternative for patients with STIS.

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Risk of progression of degenerative lumbar scoliosis

Journal of Neurosurgery Spine ◽

10.3171/2011.6.spine10929 ◽

2011 ◽

Vol 15 (5) ◽

pp. 558-566 ◽

Cited By ~ 23

Author(s):

Jun-Yeong Seo ◽

Kee-Yong Ha ◽

Tae-Hyok Hwang ◽

Ki-Won Kim ◽

Young-Hoon Kim

Keyword(s):

Vertebral Body ◽

Curve Progression ◽

Degenerative Lumbar Scoliosis ◽

Disc Space ◽

Apical Vertebra ◽

Lumbar Scoliosis ◽

The Mean ◽

Cobb Method ◽

The Relationship

Object In this paper the authors' goal was to determine the factors associated with the progression of degenerative lumbar scoliosis (DLS). Methods Twenty-seven patients (3 men and 24 women; mean age 64.9 years) with more than 10° of lumbar scoliosis at baseline were monitored for a mean period of 10 years. The radiological evaluation included measurement of the scoliosis angle using the Cobb method, the direction of the scoliosis, the relationship between the intercrest line and the L-5 vertebra, lateral listhesis, segmental angle, distance from the center of the sacral line to the apical vertebra, degenerative listhesis anteriorly or posteriorly or both, and lordosis angle. In addition, the lateral osteophyte difference, disc index, and severity of osteoporosis were measured. The pain and disability outcomes were assessed using the visual analog scale and the Oswestry Disability Index (ODI) relative to severity of the angle of scoliosis. Results The mean initial and final scoliosis angles were 14° ± 5.4° and 25° ± 8.5°, respectively. The initial disc index at the L-3 vertebra (Spearman ρ = 0.7, p < 0.001), the sum of the segmental wedging angles above and below the L-3 vertebra (ρ = 0.6, p < 0.001), and the initial disc index at the apical vertebra (ρ = 0.6, p < 0.001) were correlated with the last follow-up angle of the scoliosis. By contrast, there was no statistically significant correlation between the initial segmental angles at L2–3 and L3–4 and the final follow-up scoliosis angle (ρ = 0.2, p = 0.67; and ρ = 0.1, p = 0.22; respectively). When the authors separated the patients into 3 groups according to the sum of the segmental angles above and below L-3 (< 5°, 5° to 10°, and > 10°), they found that 3 (42.9%) of 7, 8 (66.7%) of 12, and 6 (75.0%) of 8 patients in the 3 groups showed increases of greater than 10° in scoliosis angle. The mean distance from the center of the sacral line to the apical vertebra was 36.0 ± 9.7 mm, and the distance correlated with the measurement of the last follow-up angle of the scoliosis (ρ = 0.6, p < 0.001). The mean angle of the scoliosis was significantly greater when the intercrest line passed through the L-5 or L4–5 disc space than when the line passed through the L-4 vertebral body (31.4° ± 7.9° vs 21.8° ± 6.7°, p = 0.01). The ODI correlated with the measurement of the angle of the scoliosis (ρ = 0.6, p < 0.001). Age, sex, osteoporosis, the direction of the scoliosis, listhesis of coronal and sagittal planes, the lateral osteophyte difference, and the vertebral body index did not correlate with curve progression. Conclusions The findings of this study demonstrated that the progression of DLS was affected by the relationship between the intercrest line and the L-5 vertebra. When L-5 was deep seated, progression of DLS was found. Asymmetrical change in the disc space above and below the L-3 or apical vertebra may also be an important predictor of curve progression.

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