scholarly journals The effect of pedicle subtraction osteotomy for the correction of severe Scheuermann thoracolumbar kyphosis on sagittal spinopelvic alignment

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Guanfeng Lin ◽  
Shengru Wang ◽  
Yang Yang ◽  
Zhe Su ◽  
You Du ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Pedicle Subtraction Osteotomy ◽  
Sacral Slope ◽  
Thoracolumbar Kyphosis ◽  
Spinopelvic Parameters ◽  
Pedicle Screw Instrumentation ◽  
Spinopelvic Alignment ◽  
Significant Difference ◽  
Post Operation

Abstract Purpose To analyze how pedicle subtraction osteotomy (PSO) treatment of severe Scheuermann thoracolumbar kyphosis (STLK) using pedicle screw instrumentation affects sagittal spinopelvic parameters. Background The medical literature on the post-surgical effects of treatments such as Ponte osteotomy is limited, but suggests few effects on spinopelvic profiles. Currently, there is no research regarding changes in sagittal spinopelvic alignment upon PSO treatment in STLK patients. Methods We performed a retrospective study on 11 patients with severe STLK. These patients underwent posterior-only correction surgeries with PSO and pedicle screw instrumentation between 2012 to 2017 in a single institute. Patients were measured for the following spinopelvic parameters: global kyphosis (GK), thoracic kyphosis (TK), thoracolumbar kyphosis (TL), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tile (PT), sacral slope (SS), and administered a Scoliosis Research Society-22 questionnaire (SRS-22) pre-operation, post-operation and at final follow-up. Results GK improved from a median of 74.1° to 40.0° after surgery, achieving a correction rate of 48.8% with a median correction loss of 0.8°. TK, TL and LL all showed significant difference (P < 0.05) and SVA improved 22.7 (11.6, 30.9) mm post operation. No significant difference was found in pelvic parameters (PI, PT, SS, all P < 0.05). The absolute value of LL- PI significantly improved from a median of 26.5° pre-operation to 6.1° at the final follow-up. 72.7% in this series showed an evident trend of thoracic and lumbar apices migrating closer to ideal physiological segments after surgery. Self-reported scores of pain, self-image, and mental health from SRS-22 revealed significant improvement at final follow-up (all P < 0.05). Conclusions PSO treatment of severe STLK with pedicle screw instrumentation can improve spine alignment and help obtain a proper alignment of the spine and the pelvis.

scholarly journals Predicting factors of adjacent segment degeneration after long-segment spinal fusion: spinopelvic parameters analysis

2020 ◽  
Author(s):  
Ping-Yeh Chiu ◽  
Fu-Cheng Kao ◽  
Wen-Jer Chen ◽  
Chia-Wei Yu ◽  
Chi-Chien Niu ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Control Group ◽  
Sacral Slope ◽  
Adjacent Segment ◽  
Spinopelvic Parameters ◽  
Significant Difference ◽  
Adjacent Disc

Abstract Background We investigated whether spinopelvic parameters are important prognostic factors causing adjacent segment degeneration (ASD) after long instrumented spinal fusion for degenerative spinal disease. Methods This uncontrolled, randomized, single arm retrospective study included patients who underwent long instrumented lumbar fusion (fusion levels≥ 4) in the past 5 years with follow-up for at least 2 years. The inclusion criteria included adult patients (≥40 years of age) with a diagnosis of spinal degeneration who underwent instrumented corrective surgery. The exclusion criteria included preexisting adjacent disc degeneration, combined anterior reconstructive surgery, and distal ASD. Clinical and operative characters were evaluated. Angle of lumbar lordosis (LLA), sacral slope (SSA), pelvic tilt (PTA) and pelvic incidence (PIA) were compared preoperatively, postoperatively and at the final follow-up. Results From 2009 to 2014, 60 patients (30 ASD and 30 non-ASD) were enrolled. The average age was 66.82 ± 7.48 years for the study group and 67.97 ± 7.81 years for the control group. There was no statistically significant difference in clinical and operative characteristics. Among all spinopelvic parameters, only pre-, post-operative and final follow-up PIA in ASD group (53.9±10.4ﾟ, 54.6±14.0ﾟ, 54.3±14.1ﾟ) and non-ASD group (60.3±13.0ﾟ, 61.8±11.3ﾟ, 62.5±11.2ﾟ) showed statistically significant differences ( p <0.05). Conclusion This study confirms that preoperative, postoperative and final follow-up PIA is a significant factor contributing to the development of ASD after long instrumented spinal fusion.

Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction?

2011 ◽  
Vol 14 (2) ◽  
pp. 184-191 ◽  
Author(s):  
Virginie Lafage ◽  
Frank Schwab ◽  
Shaleen Vira ◽  
Robert Hart ◽  
Douglas Burton ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Sagittal Plane ◽  
Pedicle Subtraction Osteotomy ◽  
Sacral Slope ◽  
Spinopelvic Parameters ◽  
Sagittal Vertical Axis ◽  
Significant Difference ◽  
Spinopelvic Parameter ◽  
Spinal Imbalance

Object Pedicle subtraction osteotomy (PSO) is a spinal realignment technique that may be used to correct sagittal spinal imbalance. Theoretically, the level and degree of resection via a PSO should impact the degree of sagittal plane correction in the setting of deformity. However, the quantitative effect of PSO level and focal angular change on postoperative spinopelvic parameters has not been well described. The purpose of this study is to analyze the relationship between the level/degree of PSO and changes in global sagittal balance and spinopelvic parameters. Methods In this multicenter retrospective study, 70 patients (54 women and 16 men) underwent lumbar PSO surgery for spinal imbalance. Preoperative and postoperative free-standing sagittal radiographs were obtained and analyzed by regional curves (lumbar, thoracic, and thoracolumbar), pelvic parameters (pelvic incidence and pelvic tilt [PT]) and global balance (sagittal vertical axis [SVA] and T-1 spinopelvic inclination). Correlations between PSO parameters (level and degree of change in angle between the 2 adjacent vertebrae) and spinopelvic measurements were analyzed. Results Pedicle subtraction osteotomy distribution by level and degree of correction was as follows: L-1 (6 patients, 24°), L-2 (15 patients, 24°), L-3 (29 patients, 25°), and L-4 (20 patients, 22°). There was no significant difference in the focal correction achieved by PSO by level. All patients demonstrated changes in preoperative to postoperative parameters including increased lumbar lordosis (from 20° to 49°, p < 0.001), increased thoracic kyphosis (from 30° to 38°, p < 0.001), decreased SVA and T-1 spinopelvic inclination (from 122 to 34 mm, p < 0.001 and from +3° to −4°, p < 0.001, respectively), and decreased PT (from 31° to 23°, p < 0.001). More caudal PSO was correlated with greater PT reduction (r = −0.410, p < 0.05). No correlation was found between SVA correction and PSO location. The PSO degree was correlated with change in thoracic kyphosis (r = −0.474, p < 0.001), lumbar lordosis (r = 0.667, p < 0.001), sacral slope (r = 0.426, p < 0.001), and PT (r = −0.358, p < 0.005). Conclusions The degree of PSO resection correlates more with spinopelvic parameters (lumbar lordosis, thoracic kyphosis, PT, and sacral slope) than PSO level. More importantly, PSO level impacts postoperative PT correction but not SVA.

scholarly journals High grade isthmic spondylolisthesis; can reduction always re-align the unbalanced pelvis?

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Konstantinos Martikos ◽  
Tiziana Greggi ◽  
Cesare Faldini
Keyword(s):  
Pelvic Incidence ◽  
Young Patients ◽  
Radiographic Evaluation ◽  
Sacral Slope ◽  
Isthmic Spondylolisthesis ◽  
Inclusion Criteria ◽  
Initial Attempt ◽  
Spinopelvic Alignment ◽  
Significant Difference

Abstract Background Recently, various studies have reported the importance of distinguishing between balanced and unbalanced SL, sustaining the importance of SL reduction in unbalanced cases. In this study we present our experience in the treatment of isthmic spondylolisthesis in young patients, observing the correlation between SL reduction and sagittal correlation between spine and pelvis. Methods This is a retrospective study of a series of patients treated surgically for isthmic spondylolisthesis. Inclusion criteria were L5-S1 isthmic spondylolisthesis of III° or IV°, pediatric age, clinical and radiographic follow up of at least 1 year. Radiographic evaluation included the following elements: grade and percentage of listhesis (%L), lumbar lordosis (LL), lumbar-sacral angle (LSA), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT) distinguishing between “balanced” and “unbalanced” patients. Radiographic values were confronted by using Student’s t- test, obtaining a statistically significant difference for values inferior to 0,05. Results Based on inclusion criteria, 28 patients were selected for our retrospective analysis, 19 female and 9 male. Mean age at surgery was 15,6 years. Mean follow up was 3 years and 3 months (min. 1 year – max 6 years and 7 months). Spondylolisthesis reduction was statistically significant both in balanced and in unbalanced patients, but pelvic incidence values did not improve significantly. We observed fewer mechanical complications in patients treated with interbody support. Conclusion In our study, differences between pre-op and post-op spinopelvic alignment values were not statistically significant, even though spondylolisthesis reduction was statistically significant in all cases. Our study could be considered an initial attempt to correlate spinopelvic changes to spondylolisthesis reduction in a progressive manner, and possibly in the future, generate threshold values of reduction for ideal spinopelvic alignment in every different patient.

Should instrumented spinal fusion in nonambulatory children with neuromuscular scoliosis be extended to L5 or the pelvis?

2020 ◽  
Vol 102-B (2) ◽  
pp. 261-267
Author(s):  
Niklas Tøndevold ◽  
Markus Lastikka ◽  
Thomas Andersen ◽  
Martin Gehrchen ◽  
Ilkka Helenius
Keyword(s):  
Pedicle Screw ◽  
Pelvic Obliquity ◽  
Neuromuscular Scoliosis ◽  
Sagittal Imbalance ◽  
Complication Rates ◽  
Pedicle Screw Instrumentation ◽  
Pelvic Fixation ◽  
Loss Of Correction ◽  
Significant Difference

Aims It is uncertain whether instrumented spinal fixation in nonambulatory children with neuromuscular scoliosis should finish at L5 or be extended to the pelvis. Pelvic fixation has been shown to be associated with up to 30% complication rates, but is regarded by some as the standard for correction of deformity in these conditions. The incidence of failure when comparing the most caudal level of instrumentation, either L5 or the pelvis, using all-pedicle screw instrumentation has not previously been reported. In this retrospective study, we compared nonambulatory patients undergoing surgery at two centres: one that routinely instrumented to L5 and the other to the pelvis. Methods In all, 91 nonambulatory patients with neuromuscular scoliosis were included. All underwent surgery using bilateral, segmental, pedicle screw instrumentation. A total of 40 patients underwent fusion to L5 and 51 had their fixation extended to the pelvis. The two groups were assessed for differences in terms of clinical and radiological findings, as well as complications. Results The main curve (MC) was a mean of 90° (40° to 141°) preoperatively and 46° (15° to 82°) at two-year follow-up in the L5 group, and 82° (33° to 116°) and 19° (1° to 60°) in the pelvic group (p < 0.001 at follow-up). Correction of MC and pelvic obliquity (POB) were statistically greater in the pelvic group (p < 0.001). There was no statistically significant difference in the operating time, blood loss, or complications. Loss of MC correction (> 10°) was more common in patients fixated to the pelvis (23% vs 3%; p = 0.032), while loss of pelvic obliquity correction was more frequent in the L5 group (25% vs 0%; p = 0.007). Risk factors for loss of correction (either POB or MC) included preoperative coronal imbalance (> 50 mm, odds ratio (OR) 11.5, 95%confidence interval (CI) 2.0 to 65; p = 0.006) and postoperative sagittal imbalance (> 25 mm, OR 11.0, 95% CI1.9 to 65; p = 0.008). Conclusion We found that patients undergoing pelvic fixation had a greater correction of MC and POB. The rate of complications was not different. Preoperative coronal and postoperative sagittal imbalance were associated with increased risks of loss of correction, regardless of extent of fixation. Therefore, we recommend pelvic fixation in all nonambulatory children with neuromuscular scoliosis where coronal or sagittal imbalance are present preoperatively. Cite this article: Bone Joint J 2020;102-B(2):261–267.

scholarly journals TORACOLOMBAR BURST FRACTURES AND SPINOPELVIC BALANCE

2020 ◽  
Vol 19 (2) ◽  
pp. 133-136
Author(s):  
DANIEL COSTA ◽  
OSMAR AVANZI ◽  
MARIA FERNANDA SILBER CAFFARO ◽  
ALBERTO GOTFRYD ◽  
NELSON ASTUR ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Sacral Slope ◽  
Spinopelvic Parameters ◽  
Level Of Evidence ◽  
Thoracolumbar Burst Fractures ◽  
Spinopelvic Alignment ◽  
Burst Fractures ◽  
Spinopelvic Balance ◽  
Sagittal Parameters

ABSTRACT Objective To describe the spinopelvic parameters in patients with conservatively treated thoracolumbar burst fractures. Methods Twenty-six patients with thoracolumbar burst fractures treated conservatively between 2008 and 2017 participated in the study. Inclusion criteria were acute burst-type fractures, located between T11 and L2, which compromised a single vertebral segment, did not present a neurological deficit, and had a minimum of 6 months of follow-up, excluding injuries that presented distraction or rotation, pathological fractures, and surgically treated cases. The sagittal and spinopelvic alignment parameters, including vertical sagittal axis, sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, and regional kyphosis, were analyzed. Results The values obtained for the sample showed that there was an increase in regional kyphosis and that the mean sagittal parameters and lumbar lordosis were within the values considered normal in the literature. Conclusion Patients with thoracolumbar burst fractures treated conservatively had no alterations in the spinopelvic parameters. Level of Evidence II; Retrospective study.

Variation patterns of cervical alignment in ankylosing spondylitis–related thoracolumbar kyphosis following pedicle subtraction osteotomy in the sitting position: an EOS-based investigation

2021 ◽  
pp. 1-8
Author(s):  
Shi-zhou Zhao ◽  
Bang-ping Qian ◽  
Ji-chen Huang ◽  
Mu Qiao ◽  
Bin Wang ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Pedicle Subtraction Osteotomy ◽  
Lower Cervical Spine ◽  
Cervical Lordosis ◽  
Thoracolumbar Kyphosis ◽  
Cervical Alignment ◽  
Variation Patterns ◽  
Upper Cervical ◽  
Correction Surgery

OBJECTIVE Both unchanged upper cervical lordosis combined with decreased lower cervical lordosis and decreased upper cervical lordosis combined with decreased lower cervical lordosis have been reported to occur after correction surgery for adult spinal deformity. However, variations in cervical alignment after correction surgery in patients with ankylosing spondylitis (AS) have not been investigated. The current study aimed to investigate the variations in cervical alignment following the correction surgery in AS patients with thoracolumbar kyphosis. METHODS Patients with AS who underwent pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis from June 2016 to June 2019 with a minimum of 1-year follow-up were reviewed. Patients were grouped according to the presence (ossified group) and absence (non-ossified group) of total ossification of the anterior longitudinal ligament (ALL) in the lower cervical spine. Radiographic parameters, including thoracolumbar, craniocervical, and global radiographic parameters, were measured on lateral sitting EOS images. RESULTS Thirty-two patients (27 males and 5 females) with a mean follow-up of 1.5 years were identified. There were 21 patients in the non-ossified group and 11 patients in the ossified group. After PSO, both groups showed a decrease in the occiput–C7 angle (p < 0.001 for both). In the non-ossified group, the C2–7 angle decreased significantly (p < 0.001), while the occiput–C2 angle remained unchanged (p = 0.570). In the ossified group, the occiput–C2 angle decreased significantly (p < 0.001), while C2–7 angle remained unchanged (p = 0.311). In addition, the change in occiput–C2 was correlated with the osteotomy angle in the ossified group (R = 0.776, p = 0.005). CONCLUSIONS The variation patterns of cervical alignment following correction surgery for AS-related thoracolumbar kyphosis were different based on patients with or without total ossification of ALL in the lower cervical spine. When planning PSO for patients in the ossified group, restoration of the physiological upper cervical lordosis angle could be achieved by adjusting the osteotomy angle.

Relationship between body weight and spinopelvic alignment in Chinese adult people: A preliminary study

2020 ◽  
Author(s):  
Qing Xi Zhang ◽  
Fu Qiang Gao ◽  
Yun Ting Wang ◽  
Zi Rong Li ◽  
Ozaki Koji ◽  
...  
Keyword(s):  
Body Weight ◽  
Strong Correlation ◽  
The Body ◽  
Sacral Slope ◽  
Female Group ◽  
Spinopelvic Parameters ◽  
Sagittal Abdominal Diameter ◽  
Spinopelvic Alignment ◽  
Chinese Adult ◽  
Adult Volunteers

Abstract Background: The purpose of this study is to evaluate the correlation between spinopelvicalignment and the body weight parameters in healthy Chinese adult volunteers. That has not been systematically studied yet. Methods: 100 Chinese healthy adult volunteers (36 males and 64 females) were included in this study, which grouped according to the gender. The obesity parameters, body mass index (BMI), waist circumference (WC), sagittal abdominal diameter (SAD), transverse abdominal diameter (TAD) and RR (the ratio of SAD to TAD) were measured. The sagittal spinopelvic parameters include pelvic incidence (PI), pelvic tilt (PT), pelvic angulation (PA), sacral slope (SS), sacral inclination (SI), lumbar lordosis (LL) and the disc angle of L5/S1. The coronal spinopelvic parameters include the Cobb angle of the major curve of the spine, lumbar scoliosis (LS) and pelvic obliquity (PO). Pearson's correlation analysis was used to determine correlations between obesity index and spinopelvic alignment parameters. Results: The mean BMI and WC of the males and females was 28.7 ± 3.7 kg/m2 vs 26.8 ± 2.3 kg/m2 and 88.39 ± 9 cm vs 82.6 ± 2.7 cm respectively. In the female group, a strong correlation was found between BMI and PI, WC and PT, WC and PI. However, there was no strong correlation between the obesity and spinopelvic alignment parameters in the male group. None of the coronal spinopelvic parameters showed a correlation with the obesity parameters in two groups. The RR showed a positive linear correlation with PA and PT in both groups. Conclusions: Body weight could influence the spinopelvic alignment,especially for females. People with abdominal obesity, the sagittal spinopelvic alignment is likely to change. But there is little effect on the coronal spinopelvic alignment.

Implications of Spinopelvic Alignment for the Spine Surgeon

Neurosurgery ◽  
2011 ◽  
Vol 70 (3) ◽  
pp. 707-721 ◽  
Author(s):  
Vivek A. Mehta ◽  
Anubhav Amin ◽  
Ibrahim Omeis ◽  
Ziya L. Gokaslan ◽  
Oren N. Gottfried
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Degenerative Spondylolisthesis ◽  
Disease Process ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Spinopelvic Parameters ◽  
Spinopelvic Alignment ◽  
Spinopelvic Balance

Abstract The relation of the pelvis to the spine has previously been overlooked as a contributor to sagittal balance. However, it is now recognized that spinopelvic alignment is important to maintain an energy-efficient posture in normal and disease states. The pelvis is characterized by an important anatomic landmark, the pelvic incidence (PI). The PI does not change after adolescence, and it directly influences pelvic alignment, including the parameters of pelvic tilt (PT) and sacral slope (SS) (PI = PT 1 SS), overall sagittal spinal balance, and lumbar lordosis. In the setting of an elevated PI, the spineadapts with increased lumbar lordosis. To prevent or limit sagittal imbalance, the spine may also compensate with increased PT or pelvic retroversion to attempt to maintain anupright posture. Abnormal spinopelvic parameters contribute to multiple spinal conditions including isthmic spondylolysis, degenerative spondylolisthesis, deformity, and impact outcome after spinal fusion. Sagittal balance, pelvic incidence, and all spinopelvic parameters are easily and reliably measured on standing, full-spine (lateral) radiographs, and it is essential to accurately assess and measure these sagittal values to understand their potential role in the disease process, and to promote spinopelvic balance at surgery. In this article, we provide a comprehensive review of the literature regarding the implications of abnormal spinopelvic parameters and discuss surgical strategies for correction of sagittal balance. Additionally, the authors rate and critique the quality of the literature cited in a systematic review approach to give the reader an estimate of the veracity of the conclusions reached from these reports.

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