Abstract: Purpose: This study aimed to explore the relationships between lumbar lordosis (LL) correction and improvement of postoperative global sagittal alignment and to establish corresponding linear regressions to predict the change in global tilt (GT) based on the corrected LL following adult spinal deformity (ASD) surgery.
Methods: A total of 240 ASD patients who underwent lumbar correction were enrolled in this multicentre study. The following sagittal parameters were measured pre- and postoperatively: thoracic kyphosis (TK), LL, upper and lower LL (ULL and LLL), pelvic tilt (PT), sagittal vertical axis (SVA) and GT. The correlations among the changes in GT (△GT), SVA (△SVA), PT (△PT), TK (△TK), LL (△LL), ULL (△ULL) and LLL (△LLL) were assessed, and linear regressions were conducted to predict △GT, △SVA, △PT and △TK from △LL, △ULL and △LLL.
Results: △LL was statistically correlated with △GT (r = 0.798, P < 0.001), △SVA (r = 0.678, P < 0.001), △PT (r = 0.662, P < 0.001) and △TK (r = - 0.545, P < 0.001), and the outcomes of the linear regressions are: △GT = 3.18 + 0.69 × △LL (R 2 = 0.636), △SVA = 4.78 + 2.57 × △LL (R 2 = 0.459), △PT = 2.57 + 0.34 × △LL (R 2 = 0.439), △TK = 7.06-0.43 × △LL (R 2 = 0.297). In addition, △LLL had more correlations with △GT, △SVA and △PT, while △ULL had more correlations with △TK.
Conclusion: Surgical correction of LL could contribute to the restoration of global sagittal morphology following ASD surgery. These models were established to predict the changes in sagittal parameters, in particular △GT, determined by △LL, which has not been previously done and may help to customize a more precise correction plan for ASD patients.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
References: Schwab FJ, Blondel B, Bess S et al (2013) Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976) 38(13):E803-812. (PMID: 10.1097/BRS.0b013e318292b7b923722572)
Schwab F, Ungar B, Blondel B et al (2012) Scoliosis research society-schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 37(12):1077–1082. (PMID: 10.1097/BRS.0b013e31823e15e222045006)
Pizones J, Moreno-Manzanaro L, Sánchez Pérez-Grueso FJ et al (2020) Restoring the ideal roussouly sagittal profile in adult scoliosis surgery decreases the risk of mechanical complications. Eur Spine J 29(1):54–62. (PMID: 10.1007/s00586-019-06176-x31641904)
Yilgor C, Sogunmez N, Boissiere L et al (2017) Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am 99(19):1661–1672. (PMID: 10.2106/JBJS.16.0159428976431)
Obeid I, Boissière L, Yilgor C et al (2016) Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J 25(11):3644–3649. (PMID: 10.1007/s00586-016-4649-327323962)
Ohba T, Ebata S, Oba H et al (2019) Predictors of poor global alignment and proportion score after surgery for adult spinal deformity. Spine (Phila Pa 1976) 44(19):E1136–E1143. (PMID: 10.1097/BRS.000000000000308631261271)
Kawabata A, Yoshii T, Sakai K et al (2020) Identification of predictive factors for mechanical complications after adult spinal deformity surgery: a multi-institutional retrospective study. Spine (Phila Pa 1976) 45(17):1185–1192. (PMID: 10.1097/BRS.000000000000350032205686)
Ignasiak D, Behm P, Mannion AF et al (2023) Association between sagittal alignment and loads at the adjacent segment in the fused spine: a combined clinical and musculoskeletal modeling study of 205 patients with adult spinal deformity. Eur Spine J 32(2):571–583. (PMID: 10.1007/s00586-022-07477-436526952)
Pan C, Wang G, Li Y et al (2021) Predictive model of global tilt (GT) determined by individual thoracic kyphosis, lumbar lordosis and pelvic incidence in the human degenerative spine. Eur Spine J 30(11):3191–3199. (PMID: 10.1007/s00586-021-06947-534331586)
Sebaaly A, Grobost P, Mallam L et al (2018) Description of the sagittal alignment of the degenerative human spine. Eur Spine J 27(2):489–496. (PMID: 10.1007/s00586-017-5404-029177554)
Lamartina C, Berjano P (2014) Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms. Eur Spine J 23(6):1177–1189. (PMID: 10.1007/s00586-014-3227-924682355)
Yasuda T, Hasegawa T, Yamato Y et al (2018) Postoperative change of thoracic kyphosis after corrective surgery for adult spinal deformity. Spine Surg Relat Res 2(4):283–289. (PMID: 10.22603/ssrr.2017-0081314355356690096)
Takemitsu Y, Harada Y, Iwahara T et al (1988) Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine (Phila Pa 1976) 13(11):1317–1326. (PMID: 10.1097/00007632-198811000-000192974629)
Vialle R, Levassor N, Rillardon L et al (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 87(2):260–267. (PMID: 10.2106/JBJS.D.0204315687145)
Qiao J, Zhu F, Xu L et al (2022) T1 pelvic angle: a new predictor for postoperative sagittal balance and clinical outcomes in adult scoliosis. Spine (Phila Pa 1976) 39(25):2103–2107. (PMID: 10.1097/BRS.0000000000000635)
Lafage R, Schwab F, Elysee J et al (2021) Surgical planning for adult spinal deformity: anticipated sagittal alignment corrections according to the surgical level. Glob Spine J 12(8):1761–1769. (PMID: 10.1177/2192568220988504)
Banno T, Togawa D, Arima H et al (2016) The cohort study for the determination of reference values for spinopelvic parameters (T1 pelvic angle and global tilt) in elderly volunteers. Eur Spine J 25(11):3687–3693. (PMID: 10.1007/s00586-016-4411-x26831540)
Hayashi K, Boissière L, Guevara-Villazón F (2019) Factors influencing patient satisfaction after adult scoliosis and spinal deformity surgery. J Neurosurg Spine 31(3):408–417. (PMID: 10.3171/2019.2.SPINE18148631075761)
Zhou S, Xu F, Wang W et al (2020) Age-based normal sagittal alignment in Chinese asymptomatic adults: establishment of the relationships between pelvic incidence and other parameters. Eur Spine J 29(3):396–404. (PMID: 10.1007/s00586-019-06178-931664567)
Cecchinato R, Redaelli A, Martini C et al (2017) Long fusions to S1 with or without pelvic fixation can induce relevant acute variations in pelvic incidence: a retrospective cohort study of adult spine deformity surgery. Eur Spine J 26(Suppl 4):436–441. (PMID: 10.1007/s00586-017-5154-z28555312)
Liang C, Sun J, Cui X et al (2016) Spinal sagittal imbalance in patients with lumbar disc herniation: its spinopelvic characteristics, strength changes of the spinal musculature and natural history after lumbar discectomy. BMC Musculoskelet Disord 17:305. (PMID: 10.1186/s12891-016-1164-y274442724957349)
Zavras AG, Sullivan TB, Dandu N et al (2023) Lumbar level significantly influences postoperative global sagittal balance following pedicle subtraction osteotomy. Global Spine J 13(5):1342–1349. (PMID: 10.1177/2192568221103256334263668)
Lafage V, Schwab F, Vira S et al (2011) Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine 14(2):184–191. (PMID: 10.3171/2010.9.SPINE1012921184642)
Kim HJ, Alluri RK, Lafage R et al (2022) Upper versus lower lumbar lordosis corrections in relation to pelvic tilt—an essential element in surgical planning for sagittal plane deformity. Spine (Phila Pa 1976) 47(16):1145–1150. (PMID: 10.1097/BRS.000000000000437035472199)
Pan C, Wang G, Wang X et al (2022) Predictive formulae of ideal lumbar lordosis determined by individual pelvic incidence and thoracic kyphosis in asymptomatic adults. J Orthop Sci 27(1):101–107. (PMID: 10.1016/j.jos.2020.11.02233419627)
Pan C, Wang G, Sun J et al (2020) Correlations between the inflection point and spinal sagittal alignment in asymptomatic adults. Eur Spine J 29(9):2272–2280. (PMID: 10.1007/s00586-020-06360-432130529)
Laouissat F, Sebaaly A, Gehrchen M et al (2018) Classification of normal sagittal spine alignment: refounding the roussouly classification. Eur Spine J 27(8):2002–2011. (PMID: 10.1007/s00586-017-5111-x28455623)
Processing Request
No Comments.