Changes in sagittal alignment after restoration of lower lumbar lordosis in patients with degenerative flat back syndrome

2007 ◽  
Vol 7 (4) ◽  
pp. 387-392 ◽  
Author(s):  
Jee-Soo Jang ◽  
Sang-Ho Lee ◽  
Jun-Hong Min ◽  
Dae Hyeon Maeng
Keyword(s):  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Sagittal Alignment ◽  
Plumb Line ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Spontaneous Correction ◽  
Flat Back ◽  
Lower Lumbar

Object The authors investigate the correlation between thoracic and lumbar curves in patients with degenerative flat back syndrome, and demonstrate the predictability of spontaneous correction of the thoracic curve and sacral angle after surgical restoration of lower lumbar lordosis. Methods The cases of 28 patients treated with combined anterior and posterior spinal arthrodesis were retrospectively reviewed. Inclusion criteria included loss of lower lumbar lordosis resulting in sagittal imbalance. Total lumbar lordosis, thoracic kyphosis, sacral slope, and C-7 plumb line length were measured on pre- and postoperative lateral views of the whole spine. Postoperative changes in thoracic kyphosis, sacral slope, and length of the C-7 plumb line were measured and evaluated according to extent of lumbar lordosis restoration. Results The mean (± standard deviation) preoperative sagittal imbalance was 64.6 ± 63.2 mm, which improved to 15.8 ± 20.7 mm after surgery (p < 0.0001). The preoperative mean lumbar lordosis was 15.6 ± 14.1°, which increased to 40.3 ± 14.5° at follow-up (p < 0.0001). The preoperative mean thoracic kyphosis was 1.6 ± 10.5° and increased to 17.2 ± 12.5° at follow-up (p < 0.0001). Significant preoperative correlations existed between kyphosis and lordosis (r = 0.628, p = 0.0003), and between lordosis and sacral slope (r = 0.647, p = 0.0002). Postoperative correlations also existed between kyphosis and lordosis (r = 0.718, p < 0.0001 and r = 0.690, p < 0.0001, respectively). Conclusions Lower lumbar lordosis plays an important role in sagittal alignment and balance. Surgical restoration of lumbar lordosis results in predictable spontaneous correction of the thoracic curve and sacral slope in patients with degenerative flat back syndrome.

Demands on Posterior Fusion Hardware During Lordosis Restoration Procedures

2013 ◽  
Author(s):  
Audrey Martin ◽  
Connor Telles ◽  
Jeremi Leasure ◽  
Jessica Tang ◽  
Christopher Ames ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Sagittal Alignment ◽  
Critical Role ◽  
Biomechanical Study ◽  
Posterior Fusion ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Comparative Performance ◽  
Lower Lumbar

Lower lumbar lordosis plays a critical role in sagittal alignment. It has been shown that restoration of lumbar lordosis in patients with preoperative sagittal imbalance is necessary to prevent postoperative sagittal decompensation [1]. Further, restoration of lower lumbar lordosis in patients with degenerative flatback syndrome has been shown clinically to result in additional correction of the thoracic curve and sacral slope [2]. Currently, there are three commonly used intraoperative techniques to restore lumbar lordosis: (1) cantilever bending, (2) in situ bending, and (3) compression and/or distraction of screws along posterior fusion rods. Although powerful, all three techniques require the surgeon to impart large forces to the accompanying posterior fusion hardware, often causing failure of hardware and inconsistency to achieve pre-operatively planned lordosis. To date, there has been no clinical or biomechanical study to address the comparative performance of these three techniques. In efforts to determine a standard of care for sagittal alignment via lumbar lordosis restoration, the goal of this study is to establish a relation between the three techniques, and the resulting demands on posterior fusion hardware. It is hypothesized that greater loads will be observed in the hardware during in situ bending, increasing the risk of pedicle screw pullout.

scholarly journals Clinical Outcomes of S2 Alar-Iliac (S2AI) Screw Technique in The Treatment of Severe Spinal Sagittal Imbalance: A Retrospective 2-Year Follow-Up Study

2021 ◽  
Author(s):  
Yao Zhao ◽  
Beiyu Xu ◽  
Longtao Qi ◽  
Chunde Li ◽  
Zhengrong Yu ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Pearson Correlation ◽  
Sacral Slope ◽  
Sagittal Imbalance ◽  
Global Alignment ◽  
Mechanical Complications ◽  
Group A ◽  
Group B

Abstract Background The treatment of adult spinal deformity (ASD) remains a significant challenge, especially in elderly patients. This study aimed to evaluate the outcomes of the S2AI screw technique in the treatment of severe spinal sagittal imbalance with a minimum 2-year follow-up. Methods From January 2015 to December 2018, 23 patients with severe degenerative thoracolumbar kyphosis who underwent placement of S2AI screws for long segment fusion were retrospectively reviewed. Patients were divided into group A (no mechanical complications, 13 cases) and group B (with mechanical complications, 10 cases) according to the occurrence of mechanical complications at the last follow-up. Radiographic parameters were compared between groups preoperatively, 1 month postoperatively, and at the last follow-up. Risk factors for mechanical complications were analyzed. Results The incidence of mechanical complications was 43.5%, and the revision rate was 17.4%. At 1 month postoperatively, sagittal correction was better in group A than in group B (P<0.05). The lumbar lordosis (LL), pelvic incidence minus lumbar lordosis (PI-LL), T1 pelvic angle (TPA), and sagittal vertical axis (SVA) of both groups at the last follow-up were significantly different from corresponding values at 1 month postoperatively (P<0.05), and the sagittal correction was partially lost. Pearson correlation analysis revealed that the occurrence of mechanical complications was associated with sacral slope (SS), LL, PI-LL, and global alignment and proportion (GAP) score at 1 month postoperatively. Conclusion A high incidence of mechanical complications was observed in long-segment corrective surgery with the S2AI screw technique for severe spinal sagittal imbalance. Inadequate sagittal correction is a risk factor for the development of mechanical complications.

scholarly journals Progressive restoration of spinal sagittal balance after surgical correction of lumbosacral spondylolisthesis before skeletal maturity

2015 ◽  
Vol 22 (3) ◽  
pp. 294-300 ◽  
Author(s):  
Diala Thomas ◽  
Manon Bachy ◽  
Aurélien Courvoisier ◽  
Arnaud Dubory ◽  
Houssam Bouloussa ◽  
...  
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Nonparametric Tests ◽  
Surgical Correction ◽  
Sacral Slope ◽  
Radiographic Measurements ◽  
Number Of Patients ◽  
Lumbosacral Kyphosis

OBJECT Spinopelvic alignment is crucial in assessing an energy-efficient posture in both normal and disease states, such as high-displacement developmental spondylolisthesis (HDDS). The overall effect in patients with HDDS who have undergone local surgical correction of lumbosacral imbalance for the global correction of spinal balance remains unclear. This paper reports the progressive spontaneous improvement of global sagittal balance following surgical correction of lumbosacral imbalance in patients with HDDS. METHODS The records of 15 patients with HDDS who underwent surgery between 2005 and 2010 were reviewed. The treatment consisted of L4–sacrum reduction and fusion via a posterior approach, resulting in complete correction of lumbosacral kyphosis. Preoperative, 6-month postoperative, and final follow-up postoperative angular measurements were taken from full-spine lateral radiographs obtained with the patient in a standard standing position. Radiographic measurements included pelvic incidence, sacral slope, lumbar lordosis, and thoracic kyphosis. The degree of lumbosacral kyphosis was evaluated by the lumbosacral angle. Because of the small number of patients, nonparametric tests were considered for data analysis. RESULTS Preoperative lumbosacral kyphosis and L-5 anterior slip were corrected by instrumentation. Transient neurological complications were noted in 5 patients. Statistical analysis showed a significant increase of thoracic kyphosis on 6-month postoperative and final follow-up radiographs (p < 0.001). A statistically significant decrease of lumbar lordosis was noted between preoperative and 6-month control radiographs (p < 0.001) and between preoperative and final follow-up radiographs (p < 0.001). CONCLUSIONS Based on the authors' observations, this technique resulted in an effective reduction of L-5 anterior slip and significant reduction of lumbosacral kyphosis (from 69.8° to 105.13°). Due to complete reduction of lumbosacral kyphosis and anterior trunk displacement associated with L-5 anterior slipping, lumbar lordosis progressively decreased and thoracic kyphosis progressively increased postoperatively. Adjusting the sagittal trunk balance produced not only pelvic anteversion, but also reciprocal adjustment of lumbar lordosis and thoracic kyphosis, creating a satisfactory level of compensated global sagittal balance.

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.

scholarly journals Sagittal profile modifications in hybrid versus all screw technique in adolescent idiopathic scoliosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Laura Scaramuzzo ◽  
Antonino Zagra ◽  
Giuseppe Barone ◽  
Stefano Muzzi ◽  
Leone Minoia ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Cobb Angle ◽  
Thoracic Kyphosis ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Sagittal Profile ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Lenke Classification

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

Usefulness of anterior column release for segmental lordosis restoration in degenerative lumbar kyphosis

2021 ◽  
pp. 1-7
Author(s):  
Jin-Sung Park ◽  
Chong-Suh Lee ◽  
Youn-Taek Choi ◽  
Se-Jun Park
Keyword(s):  
Sagittal Alignment ◽  
Adult Spinal Deformity ◽  
Anterior Column ◽  
Sacral Slope ◽  
High Morbidity ◽  
Global Sagittal Alignment ◽  
The Mean ◽  
Lumbar Kyphosis ◽  
Segmental Lordosis

OBJECTIVE Three-column osteotomies (3COs) for surgical correction of lumbar kyphosis show a strong correction capacity, but this procedure carries high morbidity rates. The anterior column release (ACR) technique was developed as a less invasive procedure. In this study the authors aimed to evaluate sagittal alignment restoration using ACR and to determine factors that affect the degree of correction. METHODS This study included 36 patients (68 cases) who underwent ACR of more than one level for adult spinal deformity. Parameters for regional sagittal alignment included segmental lordosis (SL). The parameters for global sagittal alignment included pelvic incidence, lumbar lordosis, sacral slope, pelvic tilt, and sagittal vertical axis (SVA). In addition, the interdiscal height (IDH) and difference of interdiscal angle (DIDA) were measured to evaluate the stiffness of the vertebra segment. The changes in SL were evaluated after ACR and the change of global sagittal alignment was also determined. Factors such as the location of the ACR level, IDH, DIDA, cage height, and additional posterior column osteotomy (PCO) were analyzed for correlation with the degree of SL correction. RESULTS Thirty-six patients were included in this study. A total of 68 levels were operated with the ACR (8 levels at L2–3, 27 levels at L3–4, and 33 levels at L4–5). ACR was performed for 1 level in 10 patients, 2 levels in 20, and 3 levels in 6 patients (mean 1.9 ± 0.7 levels per patient). Mean follow-up duration was 27.1 ± 4.2 months. The mean SL of the total segment was 0.4° ± 7.2° preoperatively and increased by 15.3° ± 5.5° at the last follow-up (p < 0.001); thus, the mean increase of SL was 14.9° ± 8.1° per one ACR. Global sagittal alignment was also improved following SL restoration with SVA from 101.9 mm to 31.4 mm. The degree of SL correction was correlated with the location of ACR level (p = 0.041) and was not correlated with IDH, DIDA, cage height and additional PCO. CONCLUSIONS This study demonstrated that the mean correction angle of SL was 14.9 per one ACR. The degree of disc space collapse and stiffness of segment did not affect the degree of correction by ACR.

scholarly journals Adolescent idiopathic scoliosis: sagital plane and low density pedicle screws

2014 ◽  
Vol 13 (1) ◽  
pp. 13-15
Author(s):  
Rodrigo Augusto do Amaral ◽  
Robert Meves ◽  
Maria Fernanda Silber Caffaro ◽  
Ricardo Shigueaki Galhego Umeta ◽  
Luciano Antônio Nassar Pelegrino ◽  
...  
Keyword(s):  
Medical Records ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Sagittal Plane ◽  
Pedicle Screws ◽  
Low Density ◽  
Kyphosis Correction ◽  
Pearson Coefficient ◽  
Analysis Of Dispersion

OBJECTIVE: To examine the sagittal curves of patients treated with CD instrumentation using exclusively pedicle screws. METHODS: Image analysis of medical records of 27 patients (26 M and 1 F) with a minimum follow-up of 6 months, who underwent surgical treatment in our service between January 2005 and December 2010. The curves were evaluated on coronal and sagittal planes, taking into account the potential correction of the technique. RESULTS: In the coronal plan the following curves were evaluated: proximal thoracic (TPx), main thoracic (TPp), and thoracolumbar; lumbar (TL, L), and the average flexibility was 52%, 52%, and 92% and the capacity of correction was 51%, 72%, and 64%, respectively. In the sagittal plane there was a mean increase in thoracic kyphosis (CT) of 41% and an average reduction of lumbar lordosis (LL) of 17%. Correlation analysis between variables showed Pearson coefficient of correlation of 0.053 and analysis of dispersion of R2 = <0.001. CONCLUSION: The method has shown satisfactory results with maintenance of kyphosis correction in patients with normal and hyper kyphotic deformities.

scholarly journals Normal Age-Adjusted Sagittal Spinal Alignment Is Achieved with Surgical Correction in Adolescent Idiopathic Scoliosis

2017 ◽  
Vol 11 (5) ◽  
pp. 770-779 ◽  
Author(s):  
Subaraman Ramchandran ◽  
Norah Foster ◽  
Akhila Sure ◽  
Thomas J. Errico ◽  
Aaron J. Buckland
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pelvic Incidence ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Surgical Correction ◽  
Sagittal Vertical Axis

<sec><title>Study Design</title><p>Retrospective analysis.</p></sec><sec><title>Purpose</title><p>Our hypothesis is that the surgical correction of adolescent idiopathic scoliosis (AIS) maintains normal sagittal alignment as compared to age-matched normative adolescent population.</p></sec><sec><title>Overview of Literature</title><p>Sagittal spino-pelvic alignment in AIS has been reported, however, whether corrective spinal fusion surgery re-establishes normal alignment remains unverified.</p></sec><sec><title>Methods</title><p>Sagittal profiles and spino-pelvic parameters of thirty-eight postsurgical correction AIS patients ≤21 years old without prior fusion from a single institution database were compared to previously published normative age-matched data. Coronal and sagittal measurements including structural coronal Cobb angle, pelvic incidence, pelvic tilt, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, C2–C7 cervical lordosis, C2–C7 sagittal vertical axis, and T1 pelvic angles were measured on standing full-body stereoradiographs using validated software to compare preoperative and 6 months postoperative changes with previously published adolescent norms. A sub-group analysis of patients with type 1 Lenke curves was performed comparing preoperative to postoperative alignment and also comparing this with previously published normative values.</p></sec><sec><title>Results</title><p>The mean coronal curve of the 38 AIS patients (mean age, 16±2.2 years; 76.3% female) was corrected from 53.6° to 9.6° (80.9%, <italic>p</italic>&lt;0.01). None of the thoracic and spino-pelvic sagittal parameters changed significantly after surgery in previously hypo- and normo-kyphotic patients. In hyper-kyphotic patients, thoracic kyphosis decreased (<italic>p</italic>=0.003) with a reciprocal decrease in lumbar lordosis (<italic>p</italic>=0.01), thus lowering pelvic incidence-lumbar lordosis mismatch mismatch (<italic>p</italic>=0.009). Structural thoracic scoliosis patients had slightly more thoracic kyphosis than age-matched patients at baseline and surgical correction of the coronal plane of their scoliosis preserved normal sagittal alignment postoperatively. A sub-analysis of Lenke curve type 1 patients (n=24) demonstrated no statistically significant changes in the sagittal alignment postoperatively despite adequate coronal correction.</p></sec><sec><title>Conclusions</title><p>Surgical correction of the coronal plane in AIS patients preserves sagittal and spino-pelvic alignment as compared to age-matched asymptomatic adolescents.</p></sec>

scholarly journals Posterior-Only Approach with Pedicle Screws for the Correction of Scheuermann's Kyphosis

2017 ◽  
Vol 11 (4) ◽  
pp. 513-519 ◽  
Author(s):  
Adem Cobden ◽  
Akif Albayrak ◽  
Yalkin Camurcu ◽  
Hakan Sofu ◽  
Temel Tacal ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pedicle Screws ◽  
Definitive Treatment ◽  
Sacral Slope ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Radiological Results ◽  
Lower Complication ◽  
Clinical And Radiological Results

<sec><title>Study Design</title><p>Retrospective study (level of evidence: level 3).</p></sec><sec><title>Purpose</title><p>The purpose of this study was to evaluate the clinical and radiological results of the posterior-only approach with pedicle screws for the treatment of Scheuermann's kyphosis (SK).</p></sec><sec><title>Overview of Literature</title><p>The correction of SK with instrumentation can be performed using posterior-only or combined anterior-posterior procedures. With the use of all-pedicle screw constructs in spine surgery, the posterior-only approach has become a popular option for the definitive treatment of SK. In a nationwide study involving 2,796 patients, a trend toward posterior-only fusion with lower complication rates was reported.</p></sec><sec><title>Methods</title><p>We retrospectively reviewed the data of patients who underwent posterior-only correction for SK between January 2005 and May 2013. Patients with a definite diagnosis of SK who fulfilled the minimum follow-up criterion of 24 months were included. The thoracic kyphosis (T5–T12), lumbar lordosis (L1–S1), and thoracolumbar junction (T10–L2) angles were measured from preoperative, postoperative, and last control radiographs. Sagittal balance, thoracic length, thoracic diameter, Voutsinas index and the sacral slope, pelvic tilt, proximal junction kyphosis, and distal junction kyphosis angles were also measured.</p></sec><sec><title>Results</title><p>Forty-five patients underwent surgery for the treatment of SK between 2005 and 2013. After applying the exclusion criteria, 20 patients (18 males and 2 females) with a mean age of 19 years were included. The mean thoracic kyphosis angle was 79.8 degrees preoperatively, 44.6 degrees postoperatively, and 44.9 degrees at the last control. There were statistically significant differences between preoperative and postoperative values in the thoracic kyphosis and lumbar lordosis angles, thoracic length, thoracic diameter, and Voutsinas index (<italic>p</italic>&lt;0.05).</p></sec><sec><title>Conclusions</title><p>The clinical and radiological results of the current study suggest that posterior-only fusion is an efficient technique for the treatment of SK.</p></sec>

scholarly journals Can posterior stand-alone expandable cages safely restore lumbar lordosis? A minimum 5-year follow-up study

2020 ◽  
Author(s):  
Seung-Kook Kim ◽  
Ogeil Mubarak Elbashier ◽  
Su-chan Lee ◽  
Woo-jin Choi
Keyword(s):  
Lumbar Lordosis ◽  
Control Group ◽  
Sacral Slope ◽  
Expandable Cage ◽  
Profile Changes ◽  
The Relationship ◽  
Screw Malposition ◽  
Segmental Angle

Abstract Background Lumbar lordosis (LL) can be restored and screw-related complications may be avoided with the stand-alone expandable cage method. However, the long-term spinopelvic profile changes and safety remain unknown. We aimed to elucidate the long-term radiologic outcomes and safety of this technique. Methods Data from a total of 69 patients who underwent multi-level stand-alone expandable cage fusion and 80 patients who underwent screw-assisted fusion between February 2007 and December 2012, with at least 5 years of follow-up, were retrospectively analyzed. Segmental angle and translation, short and whole LL, pelvic incidence, pelvic tilt, sacral slope (SS), sagittal vertical balance, thoracic kyphosis, and presence of subsidence, pseudoarthrosis, retropulsion, cage breakage, proximal junctional kyphosis (PJK), and screw malposition were assessed. The relationship between local and spinopelvic effects was investigated. The implant failure rate was considered a measure of procedure effectiveness and safety. Results The stand-alone expandable cage fusion group showed shorter operative times, a lower rate of PJK, and better improvements in segmental angles than the control group, and there was a positive correlation with LL. However, the whole LL was not restored; the SS significantly increased; and subsidence, pseudoarthrosis, and retropulsion rates were significantly higher than those in the control group. Conclusions Stand-alone expandable cage fusion can restore local lordosis, however, global sagittal balance was not restored. Furthermore, implant safety still has not been proven.

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