scholarly journals Clinical and radiological aspects of the sagittal balance of the spine in children with achondroplasia

2018 ◽  
Vol 6 (4) ◽  
pp. 6-12
Author(s):  
Oksana G. Prudnikova ◽  
Anna M. Aranovich
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Lower Limbs ◽  
Sagittal Imbalance ◽  
Compensatory Mechanisms ◽  
Lateral Instability ◽  
Hip Joints ◽  
Cross Sectional

Background. Changes in the spine with achondroplasia are represented by disorders of synostosis, the presence of wedge-shaped vertebrae, underdevelopment of the sacrum, changes in the size of the roots of the arches, stenosis of the spinal canal, and changes in the sagittal balance. Aim. To investigate the clinical and radiological features of the sagittal balance of the spine in children with achondroplasia. Materials and methods. We performed a cross-sectional clinical and radiological study of 16 patients with achondroplasia aged 6–17 years (mean, 9.2 ± 3.3 years). Radiographically, the parameters of the sagittal balance of the spine and pelvis and scoliosis were evaluated. Clinical evaluation included orthopedic and neurological status and back pain syndrome. Results. The anatomic features of patients with achondroplasia are limb shortening, O-shaped curvature of the lower extremities with lateral instability of the knee joints, and flexural contractures of the hip joints. With restriction of mobility in the hip joints, compensatory mechanisms for correcting sagittal imbalance are triggered: pelvic incline, lumbar lordosis, and thoracic kyphosis change. The clinical manifestations of sagittal imbalance in enrolled children were hypokyphosis of the thoracic spine in 100% and an increase in lumbar lordosis in 56.25% of patients. In 50% of patients, wedge-shaped deformation of vertebral bodies was diagnosed at the level of the thoracolumbar transition with the formation of local kyphosis. Neurological disorders have not been diagnosed in children. Conclusions. The anatomical features of the lower limbs and hip joints in achondroplasia reflect the biomechanical features of the relationship between the spine, pelvis, and lower limbs, which should be considered when planning for orthopedic and spinal surgery after prediction.

scholarly journals Biomechanical aspects of spinal sagittal balance in achondroplasia patients during Ilizarov limb lengthening

2018 ◽  
Vol 15 (4) ◽  
pp. 7-14
Author(s):  
O. G. Prudnikova ◽  
A. M. Aranovich ◽  
Yu. A. Mushtaeva ◽  
A. V. Gubin
Keyword(s):  
Lower Limb ◽  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Clinical Manifestations ◽  
Limb Lengthening ◽  
Neurological Status ◽  
Ilizarov Method ◽  
Sagittal Imbalance ◽  
Cross Sectional

To review specific features of spinal sagittal balance in achondroplasia patients at stages of lower limb lengthening using the Ilizarov method. Material and Methods. Cross-sectional clinical and radiological study was performed in 29 achondroplasia patients prior to lower limb lengthening and at lengthening stages using the Ilizarov method. Parameters of sagittal balance of the spine and pelvis were evaluated radiologically. Clinical evaluation included examination, and assessment of neurological status and pain level. Results. Clinical manifestations of sagittal imbalance included hypokyphosis of the thoracic spine in 44.8 % of cases and increased lumbar lordosis in 55.2 %. No neurological disorders were diagnosed in patients. Pain scores 2 to 4 were observed in 17.2 % ofcases. After staged lower limb lengthening by 19.8 ± 3.3 cm, it was revealed that the values of the thoracic kyphosis, lumbar lordosis and the angle of the sacrum tilt improved and approached those of healthy peers. Vertical sagittal alignment measurements correlated with those of thoracic kyphosis. Thoracic kyphosis showed a correlation with lumbar lordosis. Pelvic indices had a moderate correlation with lumbar lordosis. Conclusion. Biomechanically substantiated transosseous compression-distraction osteosynthesis by Ilizarov technique used for lower limb lengthening in achondroplasia patients improves spinal sagittal balance parameters.

scholarly journals Outcomes of Surgical Treatment of High-Grade Spondylolisthesis (Monocenter Cohort and Literature Review)

2019 ◽  
Vol 25 (3) ◽  
pp. 100-111
Author(s):  
S. O. Ryabykh ◽  
D. M. Savin ◽  
E. Yu. Filatov ◽  
A. O. Kotelnikov ◽  
M. S. Sayfutdinov
Keyword(s):  
Surgical Treatment ◽  
Sagittal Balance ◽  
Life Quality ◽  
Pain Syndrome ◽  
Lower Limbs ◽  
Sagittal Imbalance ◽  
High Grade ◽  
X Rays ◽  
Level Of Evidence ◽  
Severity Grade

Purpose — to evaluate outcomes of surgical treatment for high-grade spondylolisthesis using bone-disc-bone osteotomy, reduction and fixation through the dorsal approach. Materials and Methods. The authors retrospectively examined a monocenter five-year cohort (IV level of evidence). The study included 10 patients aging from 7 to 22 years (Me — 12 years, M±m — 13.1±4.1 years) who underwent surgery due to high-grade spondylolysis antelisthesis in the period from 2012 to 2017. Displacement was located in L5-S1 segments and corresponded to types 4-6 by AO Spine SDSG classification in all patients. Catamnesis was followed for the period from 1 to 5 years. Surgical procedures included bone-disc-bone osteotomy, L5 reduction and dorsal instrumental multi-bearing (from 2 to 5 spinal motion segments) using reduction transpedicular screws. The following parameters were evaluated: pain syndrome prior and after surgery, sagittal balance, spondylolisthesis mobility on the functional x-rays or CYs, severity grade of anterior spondylolysis, criteria of spontaneous muscular activity and MEPs as well as structure of postoperative complications. Results. L5 displacement prior to surgery was 92.6±25.2%, after surgery — 25.4±16.6% (Z = -2.805, p = 0.005). Patients with sagittal imbalance demonstrated normalization after the surgery allowing to re-classify pathology as “balanced spondylolisthesis”: PI from 67.9±8.6 to 67.5±8.7 (Z = 0,000, p = 1,000), PT from 26.8±13.3 to 20.1±7.1 (Z = -2,090, p = 0.037), SS from 41.3±8.7 to 47.3±9.7 (Z = -1.886, p = 0.059), SA from 34.9±36.3° to 8.6±7.1° (Z = -2.803, p = 0.005). 3 cases of transient L5 radiculopathy with full regress after conservative 6 months’ treatment were reported in the early follow up period (on day 3 after procedure). Pain syndrome dynamics on VAS scale prior to and after the surgery were as follows: spine 8.1±1.0 and 0.5±0.5 (Z = -2.814, p = 0.005), lower limbs 6.8±1.5 and 0.4±0.7 (Z = -2.812, p = 0.005), respectively. Life quality indices by SRS-24 score prior to and after the surgery were 62.6±7.9 and 90.7±12.4 (Z = -2.803, p = 0.005). Mobility of spondylolisthesis was observed in 9 patients. Spondylolisthesis severity by Bridwell classification in late period scored from 1 to 3 points. Conclusion. Use of AO Spine SDSG classification along with assessment of sagittal balance as well as severity of neurological deficit and pain syndrome allow to define the severity grade of spondylolisthesis, while normalization of parameters after the surgery speaks for positive treatment outcome. Extensive release during bone-disc-bone osteotomy at L5-S1 level along with altering tilt angle of the sacrum is the key factor for mobilization and radical correction of pelvic balance in high-grade spondylolisthesis. Outcomes of surgical treatment in the analyzed cohort demonstrate significant improvement in life quality (by SRS-24 score) and reduced pain syndrome (by VAS) in patients. At the same time precise compliance to the procedure protocol and intraoperative neuro-monitoring of MEPs allow to decrease risk of complications. 

scholarly journals Spinopelvic sagittal balance: what does the radiologist need to know?

2020 ◽  
Vol 53 (3) ◽  
pp. 175-184
Author(s):  
Leonor Garbin Savarese ◽  
Rafael Menezes-Reis ◽  
Gustavo Perazzoli Bonugli ◽  
Carlos Fernando Pereira da Silva Herrero ◽  
Helton Luiz Aparecido Defino ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Sagittal Plane ◽  
Lower Limbs ◽  
Sagittal Imbalance ◽  
Optimal Alignment ◽  
Review Of The Literature ◽  
Spinopelvic Parameters ◽  
Compensatory Mechanisms ◽  
Spinopelvic Alignment ◽  
Sagittal Malalignment

Sagittal balance describes the optimal alignment of the spine in the sagittal plane, resulting from the interaction between the spine and lower limbs, via the pelvis. Understanding sagittal balance has gained importance, especially in the last decade, because sagittal imbalance correlates directly with disability and pain. Diseases that alter that balance cause sagittal malalignment and may trigger compensatory mechanisms. Certain radiographic parameters have been shown to be clinically relevant and to correlate with clinical scores in the evaluation of spinopelvic alignment. This article aims to provide a comprehensive review of the literature on the spinopelvic parameters that are most relevant in clinical practice, as well as to describe compensatory mechanisms of the pelvis and lower limbs.

scholarly journals Peculiarities of changes in the sagittal balance of the cervical spine in cervicobrachial syndrome

2019 ◽  
Vol 16 (2) ◽  
pp. 42-48
Author(s):  
B. B. Damdinov ◽  
V. A. Sorokovikov ◽  
S. N. Larionov ◽  
Z. V. Koshkareva ◽  
O. V. Sklyarenko ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cobb Angle ◽  
Sagittal Balance ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Center Of Gravity ◽  
Sagittal Imbalance ◽  
Using Data ◽  
Mri Study ◽  
Cervicobrachial Syndrome

Objective. To analyze clinical manifestations of cervicobrachial syndrome and identify their relationship with sagittal imbalance using data of MRI and radiological examination.Material and Methods. Clinical manifestations of cervicobrachial syndrome associated with degenerative changes in the spine were studied in 22 patients. Clinical examination, radiography of the cervical spine, electroneuromyography of the upper extremities, and MRI study were performed. The intensity of the pain syndrome was assessed by VAS, and the quality of life – by the NDI questionnaire. The sagittal balance of the cervical spine was evaluated according to the following characteristics: angle of T1 slope, atlantoaxial (C1–C2) angle, degree of shift of the center of gravity of C2–C7, and Cobb angle.Results. The pain intensity in cervicobrachial syndrome correlates with sagittal balance changes in the C2–C7 Cobb angle (r = 0.656; p < 0.05), the angle of T1 vertebra slope (r = 0.520; p < 0.05), and in the degree of shift of the center of gravity of C2–C7 (r = 0.756; p < 0.02). Differences between MRI and radiological results of the sagittal balance measurement are not significant (p < 0.04).Conclusion. The study of the sagittal balance can be included in the algorithm for diagnosing osteochondrosis of the cervical spine. The MRI, along with spondylography, can be used to assess the state of sagittal balance. Understanding the identified relationships can help in determining the program of etiopathogenetic treatment of patients with cervicobrachial syndrome with obligatory including the sagittal balance correction in the program.

Spinal Balance/Alignment—Clinical Relevance and Biomechanics

2019 ◽  
Vol 141 (7) ◽  
Author(s):  
Anoli Shah ◽  
Justin V. C. Lemans ◽  
Joseph Zavatsky ◽  
Aakash Agarwal ◽  
Moyo C. Kruyt ◽  
...  
Keyword(s):  
Social Interaction ◽  
Sagittal Balance ◽  
Sagittal Plane ◽  
The Body ◽  
Optimal Configuration ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Compensatory Mechanisms ◽  
Spinal Balance ◽  
Spinal Imbalance

In the anatomy of a normal spine, due to the curvatures in various regions, the C7 plumb line (C7PL) passes through the sacrum so that the head is centered over the pelvic-ball and socket hip and ankle joints. A failure to recognize malalignment in the sagittal plane can affect the patient's activity as well as social interaction due to deficient forward gaze. The sagittal balance configuration leads to the body undertaking the least muscular activities as possible necessary to maintain spinal balance. Global sagittal imbalance is energy consuming and often results in painful compensatory mechanisms that in turn negatively influence the patient's quality of life, self-image, and social interaction due to inability to maintain a horizontal gaze. Deformity, scoliosis, kyphosis, trauma, and/or surgery are some ways that this optimal configuration can be disturbed, thus requiring higher muscular activity to maintain posture and balance. Several parameters such as the thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and hip and leg positions influence the sagittal balance and thus the optimal configuration of spinal alignment. This review examines the clinical and biomechanical aspects of spinal imbalance, and the biomechanics of spinal balance as dictated by deformities—ankylosing spondylitis (AS), scoliosis and kyphosis; surgical corrections—pedicle subtraction osteotomies (PSO), long segment stabilizations, and consequent postural complications like proximal and distal junctional kyphosis. The study of the biomechanics involved in spinal imbalance is relatively new and thus the literature is rather sparse. This review suggests several potential research topics in the area of spinal biomechanics.

Moderate Degeneration of the Lumbar Paravertebral Muscle in Patients With Dynamic Sagittal Imbalance,A retrospective cohort study

2020 ◽  
Author(s):  
Nan Ru ◽  
Guodong Wang ◽  
Yang Li ◽  
Xingang Cui ◽  
Jianmin Sun
Keyword(s):  
Retrospective Cohort ◽  
Lumbar Lordosis ◽  
Vertical Axis ◽  
Erector Spinae ◽  
Sagittal Imbalance ◽  
Mineral Density ◽  
Sagittal Vertical Axis ◽  
Cross Sectional ◽  
Paravertebral Muscle ◽  
Pelvic Parameters

Abstract Study Design: A retrospective cohort study.Background: Sagittal imbalance of the spine is a comprehensive concept and can be caused by many causes. Paravertebral muscle is an important factor in the stabilization of spine.The active subsystem formed by the muscles around the lumbar spine plays an important role in maintaining lumbar spine stability and extendding the spine . Clinically, we found that some patients showed spinal sagittal balance when they were energetic, but hunched or leaning forward after a period of walking or working.Standing full-spine lateral digital radiographs shows increased sagittal vertical axis (SVA)dynamically.We call this symptoms a dynamic sagittal imbalance（DSI. However, the sagittal sequence, paravertebral muscle changes, and the correlation between them in DSI patients have not been clearly explored. The purpose of this study was to investigate the changes of spinal-pelvic parameters; paravertebral muscle; and the relationship between the two in DSI patients .Method: The study group comprised 31 patients with DSI and 42 control patients.All subjects underwent radiologic whole spine X-ray examination and lumbar MRI( Magnetic Resonance Imaging) scanning. Spinal-pelvic parameters such as sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI) was measured. The cross-sectional areas （CSA）of the erector spinae (ES),multifidus (MF), and vertebral body were measured at L2/L3 and L4/L5. The fat infiltration (FI) and relative cross-sectional area (RCSA)of muscle of these muscles were quantitatively measured though Image J. All subjects were examined for bone mineral density and pulmonary function to test the overall skeletal muscle capacity.Result: Compared with the control group,the DSI group had a smaller lumbar lordosis，more severe fat infiltration and lower Relative functional cross-sectional area(RFCSA) of paravertebral muscle ES(erector spinae)&MF(multifidus). There was no correlation between muscle degeneration and spinal-pelvic parameters in DSI patients.In addition,There were no statistically significant differences in bone mineral density test and pulmonary function test which reflected systemic skeletal muscle capacity of whole body.Conclusion: DSI，along with moderate degeneration of the paravertebral muscles of the lumbar spine.Usually accompanied by a reduction in lumbar lordosis. DSI is regards as the pre-state of PDSI.

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.

Implications of Spinopelvic Alignment for the Spine Surgeon

Neurosurgery ◽  
2011 ◽  
Vol 76 (suppl_1) ◽  
pp. S42-S56 ◽  
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.

scholarly journals MARKER INDICATORS OF DEGENERATIVE-DYSTROPHIC PROCESSES OF THE SPINE, PELVIS AND HIP JOINTS OF DYSPLASTIC GENESIS

2018 ◽  
Vol 3 (5) ◽  
pp. 87-93
Author(s):  
Z. V. Koshkareva ◽  
M. B. Negreeva
Keyword(s):  
Mutual Influence ◽  
Plain Radiograph ◽  
Clinical Manifestations ◽  
Diagnostic Algorithm ◽  
Pain Syndrome ◽  
Lumbosacral Spine ◽  
Hip Joints ◽  
Results Of Treatment ◽  
Combined Lesions ◽  
Diagnostic Signs

Degenerative and dystrophic diseases of the spine, pelvis and hip joints are considered as a single pathogenetically conditioned process with an interdependent condition. The significance of the problem is determined by the high incidence of spinal and hip dysplasia, the syndrome of mutual burdening, the diversity and polymorphism of clinical manifestations, the growth of disability, the difficulties of diagnosis and treatment. Questions remain about the root cause of the occurrence of combined lesions, their mutual influence. The aim of the work was to identify the most common, diagnostic, pathognomonic signs of dysplastic syndrome. The patients were examined according to a single diagnostic algorithm, including clinical and neurological examination, plain radiograph of the pelvis; spondylography, MSCT, MRI of the lumbar and lumbosacral spine; study of the locomotion act of walking, anthropometric measurements; statistical methods. We analyzed the results of treatment of 39 patients (26 women and 13 men; mean age – 53 years) with dysplastic syndrome including degenerative-dystrophic changes in the spine, pelvis and hip joints. The most common diagnostic signs of combined degenerative-dystrophic diseases of the spine and pelvis have been established, among which pain syndrome, noted in varying degrees in all patients. The established diagnostic indices, supplementing existing knowledge of the problem studied, will allow to specify diagnostics and optimize the treatment of combined degenerative-dystrophic diseases of dysplastic genesis.

RADIOGRAPHIC RESTORATION OF LUMBAR ALIGNMENT AFTER TRANSFORAMINAL LUMBAR INTERBODY FUSION

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 955-964 ◽  
Author(s):  
Jay Jagannathan ◽  
Charles A. Sansur ◽  
Rod J. Oskouian ◽  
Kai-Ming Fu ◽  
Christopher I. Shaffrey
Keyword(s):  
Surgical Technique ◽  
Cobb Angle ◽  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Sagittal Imbalance ◽  
X Rays ◽  
Lumbar Interbody Fusion ◽  
Spinal Alignment

Abstract OBJECTIVE Restoration of lumbar lordosis is a critical factor in long-term success after lumbar fusions. Transforaminal lumbar interbody fusion (TLIF) is a popular surgical technique in the lumbar spine, but few data exist on change in spinal alignment after the procedure. METHODS Eighty patients who underwent TLIF surgery were retrospectively reviewed (minimum follow-up period, 2 years). Standing x-rays were assessed for changes in focal and segmental kyphosis, and restoration of lumbar lordosis. Improvement in spondylolisthesis, sagittal balance, and scoliosis were also assessed. Fusion was assessed as well. RESULTS Eighty operations were performed at 107 levels. Mean presenting lumbar Cobb angle measurement (L1–S1) was 36.3 ± 4.5 degrees (range, 12–77 degrees). Forty patients (50%) had sagittal imbalance. Mean postoperative Cobb angle (L1–S1) was 55.1 ± 6.6. Thirty-three of 36 patients with segmental kyphosis (92%) had restoration of lordosis. Improvement in alignment was most prominent at the surgical level (mean increase in lordosis, 20.2 ± 4.2 degrees). The improvement in lumbar lordosis among patients undergoing multilevel TLIFs (27.3 ± 3.4 degrees) was significantly higher compared with patients undergoing single-level operations (17.4 ± 4.4) (Student's t test, P = 0.0004). Thirty of the 40 patients with sagittal imbalance (75%) achieved immediate restoration of normal sagittal balance. The ability to restore normal sagittal balance was correlated with a sagittal imbalance of less than 10 cm (P = 0.0001). Spondylolisthesis was completely corrected at the TLIF site in 90 of 99 levels (91%). Three patients (4%) required reoperation, 2 for implant disengagement and 1 for worsening kyphoscoliosis above the original surgical levels. Two of the 80 patients had pseudoarthrosis; hence, the rate of pseudoarthrosis was 2.5%. CONCLUSION The TLIF operation is highly effective in improving spinal alignment in patients with degenerative spinal disorders when the appropriate surgical technique is implemented.

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