Saturday, September 29, 2018 10:30 am–12:00 pm Applying Deformity Concepts in Your Practice

Abstract

BACKGROUND CONTEXT Standing spinal alignment has been the center of focus recently, particularly in the setting of adult spinal deformity. While lumbopelvic sagittal alignment has been shown to adapt from standing to sitting posture, segmental vertebral alignment of the entire spine is not yet fully understood, nor the effects of degeneration (DEGEN) or flatback deformity (DEFORMITY). Segmental spinal alignment between sitting and standing and the effects of DEGEN and DEFORMITY was analyzed. PURPOSE To determine how sitting and standing segmental spinal alignment are altered with lumbar DEGEN and DEFORMITY compared to patients with NORMAL lumbar spines. STUDY DESIGN/SETTING Retrospective radiographic review. PATIENT SAMPLE A total of 491 patients with full body sitting & standing radiographs at a single institution. OUTCOME MEASURES Segmental spinal alignment & lumbopelvic alignment (pelvic tilt [PT], pelvic incidence [PI], lumbar lordosis [LL], PI-LL, sacral slope). METHODS Lumbar spines were classified as NORMAL, DEGEN (at least one level of disc height loss >50%, facet arthropathy, or spondylolisthesis) or DEFORMITY (PI-LL mismatch>10°). Exclusion criteria included lumbar fusion or ankylosis, hip arthroplasty, and transitional lumbosacral anatomy. Independent samples t-tests analyzed lumbopelvic and segmental alignment between sitting and standing within groups. ANOVA assessed these differences between spine pathology groups. RESULTS There were 183 NORMAL, 216 DEGEN and 92 DEFORMITY patients with significant differences in age, gender and hip OA grades. After propensity matching for these factors, there were 56 patients in each group (age 63±14, 58% female). Significant differences were noted between spinal pathology groups with regard to changes from standing and sitting alignment with regard to NORMAL versus DEGEN versus DEFORMITY groups: Standing: Significant differences were noted in PT(13.13° vs. 14.08° vs. 24.30°, p CONCLUSIONS The lower lumbar spine provides the greatest sitting to standing change in lumbopelvic alignment in normal patients. Degeneration and deformity of the spine significantly reduces the mobility of the lower lumbar spine and PT. With lumbar spine degeneration and flatback deformity, relatively more alignment change occurs at the upper lumbar spine and thoracolumbar junction FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.