scholarly journals Effect of position on lumbar lordosis in patients with adult spinal deformity

2018 ◽  
Vol 29 (5) ◽  
pp. 530-534 ◽  
Author(s):  
Tatsuya Yasuda ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Daisuke Togawa ◽  
Sho Kobayashi ◽  
...  
Keyword(s):  
Prone Position ◽  
Spinal Deformity ◽  
Supine Position ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Standing Position ◽  
Spinopelvic Parameters ◽  
Fusion Surgery ◽  
The Difference ◽  
Radiographic Data

OBJECTIVEThe purpose of this study was to evaluate the effect of position on lumbar lordosis (LL) in adult spinal deformity (ASD) patients.METHODSThe authors evaluated the radiographic data of ASD patients who underwent posterior corrective fusion surgery from the thoracic spine to L5, S1, or the ilium for the treatment of ASD of the lumbar spine. The spinopelvic parameters were measured in the standing position preoperatively. LL was also evaluated in the supine position preoperatively and in the prone position on the surgical frame. Changes in LL were compared between groups.RESULTSEighty-five patients were included. The average LL in standing, supine, and prone positions was 11.8°, 24.3°, and 24.0°, respectively. LL increased significantly from standing to supine or prone position (p < 0.001). In 80 patients (94.1%), the difference between supine LL and prone LL was within 5°. Change in LL from standing to prone position was significantly higher in the severe deformity group.CONCLUSIONSThe lordotic effect of intraoperative prone positioning was remarkable in patients with severe deformities. LL in the supine position was approximately the same as that in the prone position. Therefore, assessing preoperative supine lateral lumbar radiographs enables one to plan corrective spinal surgeries in ASD patients.

Long fusion from sacrum to thoracic spine for adult spinal deformity with sagittal imbalance: upper versus lower thoracic spine as site of upper instrumented vertebra

2014 ◽  
Vol 36 (5) ◽  
pp. E9 ◽  
Author(s):  
Takahito Fujimori ◽  
Shinichi Inoue ◽  
Hai Le ◽  
William W. Schairer ◽  
Sigurd H. Berven ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Adult Spinal Deformity ◽  
Sagittal Imbalance ◽  
Fusion Surgery ◽  
Significant Difference ◽  
Upper Instrumented Vertebra

Object Despite increasing numbers of patients with adult spinal deformity, it is unclear how to select the optimal upper instrumented vertebra (UIV) in long fusion surgery for these patients. The purpose of this study was to compare the use of vertebrae in the upper thoracic (UT) versus lower thoracic (LT) spine as the upper instrumented vertebra in long fusion surgery for adult spinal deformity. Methods Patients who underwent fusion from the sacrum to the thoracic spine for adult spinal deformity with sagittal imbalance at a single medical center were studied. The patients with a sagittal vertical axis (SVA) ≥ 40 mm who had radiographs and completed the 12-item Short-Form Health Survey (SF-12) preoperatively and at final follow-up (≥ 2 years postoperatively) were included. Results Eighty patients (mean age of 61.1 ± 10.9 years; 69 women and 11 men) met the inclusion criteria. There were 31 patients in the UT group and 49 patients in the LT group. The mean follow-up period was 3.6 ± 1.6 years. The physical component summary (PCS) score of the SF-12 significantly improved from the preoperative assessment to final follow-up in each group (UT, 34 to 41; LT, 29 to 37; p = 0.001). This improvement reached the minimum clinically important difference in both groups. There was no significant difference in PCS score improvement between the 2 groups (p = 0.8). The UT group had significantly greater preoperative lumbar lordosis (28° vs 18°, p = 0.03) and greater thoracic kyphosis (36° vs 18°, p = 0.001). After surgery, there was no significant difference in lumbar lordosis or thoracic kyphosis. The UT group had significantly greater postoperative cervicothoracic kyphosis (20° vs 11°, p = 0.009). The UT group tended to maintain a smaller positive SVA (51 vs 73 mm, p = 0.08) and smaller T-1 spinopelvic inclination (−2.6° vs 0.6°, p = 0.06). The LT group tended to have more proximal junctional kyphosis (PJK), although the difference did not reach statistical significance. Radiographic PJK was 32% in the UT group and 41% in the LT group (p = 0.4). Surgical PJK was 6.4% in the UT group and 10% in the LT group (p = 0.6). Conclusions Both the UT and LT groups demonstrated significant improvement in clinical and radiographic outcomes. A significant difference was not observed in improvement of clinical outcomes between the 2 groups.

Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study

2014 ◽  
Vol 20 (5) ◽  
pp. 515-522 ◽  
Author(s):  
Jotham C. Manwaring ◽  
Konrad Bach ◽  
Amir A. Ahmadian ◽  
Armen R. Deukmedjian ◽  
Donald A. Smith ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Cobb Angle ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Adult Spinal Deformity ◽  
Spinal Instrumentation ◽  
Sagittal Imbalance ◽  
Lumbar Interbody Fusion ◽  
Spinopelvic Parameters

Object Minimally invasive (MI) fusion and instrumentation techniques are playing a new role in the treatment of adult spinal deformity. The open pedicle subtraction osteotomy (PSO) and Smith-Petersen osteotomy (SPO) are proven segmental methods for improving regional lordosis and global sagittal parameters. Recently the MI anterior column release (ACR) was introduced as a segmental method for treating sagittal imbalance. There is a paucity of data in the literature evaluating the alternatives to PSO and SPO for sagittal balance correction. Thus, the authors conducted a preliminary retrospective radiographic review of prospectively collected data from 2009 to 2012 at a single institution. The objectives of this study were to: 1) investigate the radiographic effect of MI-ACR on spinopelvic parameters, 2) compare the radiographic effect of MI-ACR with PSO and SPO for treatment of adult spinal deformity, and 3) investigate the radiographic effect of percutaneous posterior spinal instrumentation on spinopelvic parameters when combined with MI transpsoas lateral interbody fusion (LIF) for adult spinal deformity. Methods: Patient demographics and radiographic data were collected for 36 patients (9 patients who underwent MI-ACR and 27 patients who did not undergo MI-ACR). Patients included in the study were those who had undergone at least a 2-level MI-LIF procedure; adequate preoperative and postoperative 36-inch radiographs of the scoliotic curvature; a separate second-stage procedure for the placement of posterior spinal instrumentation; and a diagnosis of degenerative scoliosis (coronal Cobb angle > 10° and/or sagittal vertebral axis > 5 cm). Statistical analysis was performed for normality and significance testing. Results Percutaneous transpedicular spinal instrumentation did not significantly alter any of the spinopelvic parameters in either the ACR group or the non-ACR group. Lateral MI-LIF alone significantly improved coronal Cobb angle by 16°, and the fractional curve significantly improved in a subgroup treated with L5–S1 transforaminal lumbar interbody fusion. Fifteen ACRs were performed in 9 patients and resulted in significant coronal Cobb angle correction, lumbar lordosis correction of 16.5°, and sagittal vertebral axis correction of 4.8 cm per patient. Segmental analysis revealed a 12° gain in segmental lumbar lordosis and a 3.1-cm correction of the sagittal vertebral axis per ACR level treated. Conclusions The lateral MI-LIF with ACR has the ability to powerfully restore lumbar lordosis and correct sagittal imbalance. This segmental MI surgical technique boasts equivalence to SPO correction of these global radiographic parameters while simultaneously creating additional disc height and correcting coronal imbalance. Addition of posterior percutaneous instrumentation without in situ manipulation or overcorrection does not alter radiographic parameters when combined with the lateral MI-LIF.

scholarly journals Comparison of Radiographic And Clinical Outcomes Observed After Adult Spinal Deformity Correction Using Iliac Screw Versus S2-Alar-Iliac Screw

2021 ◽  
Author(s):  
Qiang Luo ◽  
Yong-Chan Kim ◽  
Ki-Tack Kim ◽  
Kee-Yong Ha ◽  
Joonghyun Ahn ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Postoperative Change ◽  
Iliac Screw ◽  
Vas Scores ◽  
Correction Surgery

Abstract Background: To date, there is a paucity of reports clarifying the change of spinopelvic parameters in patients with adult spinal deformity (ASD) who underwent long segment spinal fusion using iliac screw (IS) and S2-alar-iliac screw (S2AI) fixation.Methods: A retrospective review of consecutive patients underwent deformity correction surgery for ASD between 2013 and 2017 was performed. Patients were divided into two groups based on whether IS or S2AI fixation was performed. All radiographic parameters were measured preoperatively, immediately postoperatively, and the last follow-up. Demographics, intraoperative and clinical data were analyzed between the two groups. Additionally, the cohort was subdivided according to the postoperative change in pelvic incidence (PI): subgroup (C) was defined as change in PI ≥5° and subgroup (NC) with change <5°. In subgroup analyses, the 2 different types of postoperative change of PI were directly compared.Results: A total of 142 patients met inclusion criteria: 111 who received IS and 31 received S2AI fixation. The IS group (65.6 ± 26, 39.8 ± 13.8) showed a significantly higher change in lumbar lordosis (LL) and upper lumbar lordosis (ULL) than the S2AI group (54.4 ± 17.9, 30.3 ± 9.9) (p<0.05). In subgroup (C), PI significantly increased from 53° preoperatively to 59° postoperatively at least 50% of IS cohort, with a mean change of 5.8° (p<0.05). The clinical outcomes at the last follow-up were significantly better in IS group than in S2AI group in terms of VAS scores for back and leg. The occurrence of sacroiliac joint pain and pelvic screw fracture were significantly greater in S2AI group than in IS group (25.8% vs 9%, p<0.05) and (16.1% vs 3.6%, p<0.05).Conclusions: IS fixation showed a greater change in LL and ULL than S2AI fixation in ASD surgery. PI may be changed under certain circumstances.

The Incidence of Iliac Screw-Related Complications After Long Fusion Surgery in Patients with Adult Spinal Deformity

Spine ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Tomohiro Banno ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Hideyuki Arima ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Fusion Surgery ◽  
Iliac Screw

scholarly journals Supine Imaging Is a Superior Predictor of Long-Term Alignment Following Adult Spinal Deformity Surgery

2020 ◽  
pp. 219256822096075
Author(s):  
Jonathan Charles Elysee ◽  
Francis Lovecchio ◽  
Renaud Lafage ◽  
Bryan Ang ◽  
Alex Huang ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Pelvic Incidence ◽  
Lumbar Fusion ◽  
Adult Spinal Deformity ◽  
Multilinear Regression ◽  
Sagittal Vertical Axis ◽  
Type Curve ◽  
Scoliosis Research Society ◽  
Correlation Analyses

Study Design: Retrospective cohort study. Objective: To investigate correlations between preoperative supine imaging and postoperative alignment. Methods: A retrospective review was conducted of a single-institution database of patients with adult spinal deformity (ASD). Patients were stratified by fusion location in the lumbar or thoracic spine. Outcomes of interest were postoperative lumbar lordosis (LL) and thoracic kyphosis (TK). Sagittal alignment parameters were compared and correlation analyses were performed. Multilinear stepwise regression was conducted to identify independent predictors of postoperative LL or TK. Regression analyses were repeated within the lumbar and thoracic fusion cohorts. Results: A total of 99 patients were included (mean age 63.2 years, 83.1% female, mean body mass index 27.3 kg/m2). Scoliosis Research Society classification demonstrated moderate to severe sagittal and/or coronal deformity (pelvic tile modifier, 18.2% ++; sagittal vertical axis, 27.3% ++, pelvic incidence minus lumbar lordosis mismatch, 29.3% ++, SRS type, 29.3% N type curve and 68.7% L or D type curve). A total of 73 patients (73.7%) underwent lumbar fusion and 50 (50.5%) underwent thoracic fusion. Correlation analyses demonstrated a significant association between pre- and postoperative LL and TK. Multilinear regression demonstrated that LL supine and pelvic incidence were significant predictors of postoperative LL ( r 2 = 0.568, P < .001). LL supine, TK supine, and age were significant predictors of postoperative TK ( r 2 = 0.490, P < .001). Conclusion: Preoperative supine films are superior to standing in predicting postoperative alignment at 1-year follow-up. Anticipation of undesired alignment changes through supine imaging may be useful in mitigating the risk of iatrogenic malalignment.

Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 489-497 ◽  
Author(s):  
Juan S. Uribe ◽  
Joshua Beckman ◽  
Praveen V. Mummaneni ◽  
David Okonkwo ◽  
Pierce Nunley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Radiographic Parameters ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

scholarly journals Treatment strategy for rod fractures following corrective fusion surgery in adult spinal deformity depends on symptoms and local alignment change

2018 ◽  
Vol 29 (1) ◽  
pp. 59-67 ◽  
Author(s):  
Yu Yamato ◽  
Tomohiko Hasegawa ◽  
Sho Kobayashi ◽  
Tatsuya Yasuda ◽  
Daisuke Togawa ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Revision Surgery ◽  
Treatment Strategy ◽  
Time Course ◽  
Clinical Symptoms ◽  
Adult Spinal Deformity ◽  
Nonoperative Treatment ◽  
Local Alignment ◽  
Fusion Surgery

OBJECTIVEDespite the significant incidence of rod fractures (RFs) following long-segment corrective fusion surgery, little is known about the optimal treatment strategy. The objectives of this study were to investigate the time course of clinical symptoms and treatments in patients with RFs following adult spinal deformity (ASD) surgery and to establish treatment recommendations.METHODSThis study was a retrospective case series of patients with RFs whose data were retrieved from a prospectively collected single-center database. The authors reviewed the cases of 304 patients (mean age 62.9 years) who underwent ASD surgery. Primary symptoms, time course of symptoms, and treatments were investigated by reviewing medical records. Standing whole-spine radiographs obtained before and after RF development and at last follow-up were evaluated. Osseous union was assessed using CT scans and intraoperative findings.RESULTSThere were 54 RFs in 53 patients (mean age 68.5 years [range 41–84 years]) occurring at a mean of 21 months (range 6–47 months) after surgery. In 1 patient RF occurred twice, with each case at a different time and level, and the symptoms and treatments for these 2 RFs were analyzed separately (1 case of revision surgery and 1 case of nonoperative treatment). The overall rate of RF observed on radiographs after a minimum follow-up of 1 year was 18.0% (54 of 300 cases). The clinical symptoms at the time of RF were pain in 77.8% (42 of 54 cases) and no onset of new symptoms in 20.5% (11 of 54 cases). The pain was temporary and had subsided in 19 of 42 cases (45%) within 2 weeks. In 36 of the 54 cases (66.7%) (including the first RF in the patient with 2 RFs), patients underwent revision surgery at a mean of 116 days (range 5–888 days) after diagnosis. In 18 cases patients received only nonoperative treatment as of the last follow-up, including 17 cases in which the patients experienced no pain and no remarkable progression of deformity (mean 18.5 months after RF development).CONCLUSIONSThis analysis of 54 RFs in 53 patients following corrective fusion surgery for ASD demonstrates a relationship between symptoms and alignment change. Revision surgeries were performed in a total of 36 cases. Nonoperative care was offered in 18 (33.3%) of 54 cases at the last follow-up, with no additional symptoms in 17 of the 18 cases. These data offer useful information regarding informed decision making for patients in whom an RF occurs after ASD surgery.

scholarly journals Improvement of pulmonary dysfunction in patients with severe adult spinal deformity after corrective spinal fusion surgery

2018 ◽  
Vol 4 (2) ◽  
pp. 15
Author(s):  
Yuki Mihara ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Sho Kobayashi ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pulmonary Function ◽  
Cobb Angle ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Low Back ◽  
Pulmonary Dysfunction ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery

In some cases of adolescent idiopathic scoliosis, corrective surgery can improve pulmonary function. However, the effectiveness of corrective surgery in improving pulmonary function in adult spinal deformity (ASD) has not been reported. Therefore, the purpose of our study was to investigate the recovery of pulmonary function after corrective fusion surgery in 4 patients with severe ASD and associated pulmonary dysfunction. The first patient was a 42-year-old woman with spondylo-epiphyseal dysplasia, whose main presenting complaint was dyspnea. As a result of her respiratory dysfunction, associated with her severe spinal deformity, she required Home Oxygen Therapy (HOT). Prior to surgery, her %vital capacity (VC) was 25%, with a kyphosis angle of 170°. The second patient was a 55-year-old woman with a history of acromegaly, who presented with low back pain. Prior to surgery, she had a %VC of 48% and a Cobb angle of 85°. The third patient was a 59-year-old woman with adolescent idiopathic scoliosis, which had been previously treated, and who was now experiencing increasing low back pain. Prior to surgery, she had a %VC of 58% and a Cobb angle of 87°. The fourth patient was a 60-year-old man, with a history of tuberculous spine, who presented with low back pain. Prior to surgery, his %VC of 75% and Cobb angle of 100°. Pulmonary function improved after corrective fusion surgery in all cases. Halo traction with respiratory rehabilitation should be recommended before corrective spinal fusion surgery for patients with severe ASD and pulmonary dysfunction.

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