Changes In Spinopelvic Parameters Research Articles

Radiological Spinopelvic Parameters Can Be Risk Factors for Early Total Hip Replacement After Spine Fusion.

Interest in the correlation between the spinopelvic complex and its radiographic parameters in early total hip arthroplasty has been increasing. This study investigated whether radiological spinopelvic parameters are risk factors for early total hip replacement (THR) within 1 year of spinal fusion surgery. The primary research question focused on identifying specific spinopelvic changes that may lead to early THR. We retrospectively analyzed patients who underwent lumbar spinal fusion between 2016 and 2021. The patients were divided into 2 groups: patients who underwent early THR (n = 35) and patients who did not (n = 213). Spinopelvic parameters, including pelvic incidence (PI), sacral slope (SS), pelvic tilt, lumbar lordosis, thoracolumbar kyphosis (TLK), sagittal vertical axis, and thoracic kyphosis (TK), were measured before and after surgery. The statistical analyses included inverse probability of treatment weighting, independent t tests, χ 2 tests, and logistic regression analyses. A total of 248 patients were included in the study. The pre- and postoperative TLK and TK angles were significantly smaller in the early THR group than in the late THR group. Increases in the PI and SS after surgery were significant risk factors. The use of interbody fusion techniques was associated with a higher rate of early THR. The difference in the PI minus lumbar lordosis before and after surgery was also significantly correlated with early THR. Abnormal spinopelvic parameters, especially reduced TLK and TK angles and increased PI and SS, are risk factors for early THR. Changes in spinopelvic parameters can lead to rapid hip joint destruction, which highlights the need for careful preoperative evaluation and postoperative monitoring of patients to prevent early THR.

Contemporary insights into spinopelvic mechanics.

Understanding spinopelvic mechanics is important for the success of total hip arthroplasty (THA). Despite significant advancements in appreciating spinopelvic balance, numerous challenges remain. It is crucial to recognize the individual variability and postoperative changes in spinopelvic parameters and their consequential impact on prosthetic component positioning to mitigate the risk of dislocation and enhance postoperative outcomes. This review describes the integration of advanced diagnostic approaches, enhanced technology, implant considerations, and surgical planning, all tailored to the unique anatomy and biomechanics of each patient. It underscores the importance of accurately predicting postoperative spinopelvic mechanics, selecting suitable imaging techniques, establishing a consistent nomenclature for spinopelvic stiffness, and considering implant-specific strategies. Furthermore, it highlights the potential of artificial intelligence to personalize care.

Correlations of spinopelvic parameters with quality of life of patients with adult degenerative scoliosis after posterior correction.

This study aimed to investigate the correlations of spinopelvic parameters with the quality of life of patients with adult degenerative scoliosis (ADS) after posterior correction, and their relationships with efficacy Patients and methods: Ninety patients (40 females, 50 males; mean age: 62.4±3.3 years; range, 47 to 73 years) with adult spinal deformity treated from March 2016 to May 2020 were retrospectively enrolled. The Scoliosis Research Society (SRS)-22 questionnaire was filled in by the patients, and the Oswestry disability index (ODI) and Visual Analog Scale (VAS) for back and lower limb pain were assessed. All the patients underwent posterior correction. Spearman's analysis was conducted for the correlations of the spinopelvic sagittal parameters with quality of life. The risk factors for efficacy were identified using the multivariate logistic regression model to construct a nomogram model for efficacy and risk prediction. After the operation, significant reductions were detected in the sagittal vertical axis (SVA), pelvic tilt (PT), T1 pelvic angle (TPA), pelvic incidence minus lumbar lordosis (PI-LL), and the ODI score (p<0.05). The SVA and LL were significantly negatively correlated with all subitems on the SRS-22 questionnaire but positively correlated with VAS scores for back pain (p<0.05). Thoracic kyphosis was significantly positively correlated with self-image and mental status on the SRS-22 questionnaire (p<0.05), while TPA was negatively correlated with pain and self-image (p<0.05). The PI-LL was significantly negatively correlated with pain (p<0.05). The SVA, LL, PT, and PI-LL were independent predictors of improvement in ODI after operation for ADS. The postoperative changes in spinopelvic parameters affected the clinical outcomes in patients with ADS.

Outcomes and Spinopelvic Changes After Anterior Lumbar Interbody Fusion With a Novel Interbody Fusion Device: A Retrospective Study.

Interbody devices in anterior lumbar interbody fusion (ALIF) are currently a focus of innovation due to their potential to improve clinical outcomes. The purpose of the present study was to analyze complications and changes in spinopelvic parameters after ALIF with the novel Medacta MectaLIF interbody fusion device. Patients aged 18 to 80 years who underwent multilevel ALIF using this novel implant were identified. Demographic and surgical data were collected. Patients were divided into short- and long-fusion cohorts. A comparison of outcomes between the short- and long-fusion groups was performed using the Student t test for continuous variables and Fisher's exact test and the χ2 test for categorical variables. Analysis of the pre- vs postoperative radiographic data for the entire cohort was performed using the 2-tailed Student t test. One hundred and eight patients met the inclusion criteria. No significant postoperative change was observed in L1-4 lumbar lordosis (LL). L1-S1 LL increased to a mean of 55.1 ± 12.8 (a mean change of 10.7 ± 14.5), and L4-S1 LL increased to a mean of 38.4 ± 8.7 (a mean increase of 7.5 ± 8.2), with pelvic incidence LL mismatch changing from 8.9 ± 15.1 to 1.1 ± 13.5 (n = 102). Related changes in sacral slope and pelvic tilt were also observed (33.0 ± 11.0 to 37.6 ± 10.9 and 19.6 ± 9.5 to 18.2 ± 9.1 [n = 103], respectively). Five patients (4.6%) experienced implant subsidence, 1 (0.9%) had implant migration, and 6 (5.6%) experienced a nonunion. There was no difference in the rates of complications associated with the novel implant in the short- and long-fusion cohorts. This novel implant achieves correction of spinopelvic parameters with minimal complications. The ability to modify the implant intraoperatively based on the patient's anatomy can help achieve maximal contact area and therefore help reduce the risk of subsidence. This modular implant can achieve correction of spinopelvic parameters with minimal medical and surgical complications.

Association of Body Mass Index and Central Obesity with Spinopelvic Alignment Parameters in a Chinese Population: A Prospective Study

The purpose of this study was to explore the impact of central obesity on spinal sagittal balance in adults aged 18 and older by examining correlations between waist circumference (WC) and abdominal circumference (AC) and spinopelvic alignment parameters. This prospective cohort study included 350 adults aged 18 and older. Participants underwent whole-body biplanar radiography using the EOS imaging system. Spinal and pelvic parameters were measured and correlated with body mass index, WC, and AC. Statistical analyses included one-way analysis of variance, Wilcoxon rank-sum tests for data with nonhomogeneous variances, and chi-squared tests for categorical data. Intra-rater and inter-rater reliability were assessed using intraclass correlation coefficients, with subsequent analyses to explore correlations between body measurements and spinal parameters. The study found significant correlations between increased WC and AC and changes in spinopelvic parameters. However, obesity did not uniformly influence all sagittal alignment parameters. Significant variations in spinal measurements indicate that central obesity plays a role in altering spinal stability and alignment. The findings highlight the impact of central obesity on spinal alignment and emphasize the importance of considering central obesity in clinical assessments of spinal pathologies. Further research is essential to better understand the relationship between obesity, spinal sagittal balance, and related health conditions.

Examination of Age and Gender-Related Changes in Spinopelvic Parameters in Children and Adolescents Using Computed Tomography Images

Aim: In order for a person to stand in a balanced way, the pelvis and spine must be in harmony. The aim of this study was to determine the normal ranges of spinopelvic parameters in children and adolescents in Türkiye. Material and Method: In our study, computed tomography images of 1018 healthy 7-17 year olds were examined. As a result of this examination, sacrum pubic incidence, lumbar lordosis, sacral slope, sacral kyphosis, pelvic tilt and pelvic incidence were measured. Results: The sacrum pubic incidence was 58.71±6.17°, sacral slope 37.26±5.77, lumbar lordosis 42.98±8.06°, sacral kyphosis 21.27±9.96°, pelvic incidence 46.77±6.38, and pelvic tilt 9.51±5.06°. The calculations revealed that, with age, all parameters except pelvic tilt increased significantly. A statistically significant difference was found between the age groups. Conclusion: The results of this study will contribute to the existing literature and may give clinicians insight into sagittal corrections in spine and pelvic surgery.

Changes in spinal sagittal balance after a new osteoporotic vertebral compression fracture.

Studies on the relationship between osteoporotic vertebral fractures and spinal sagittal balance have all been limited to cross-sectional studies. The aim of this study is to conduct a longitudinal study to examine how new vertebral compression fracture (VCF) alter spinal sagittal balance. Subjects were patients undergoing periodic examinations after treatment of a vertebral fracture or lumbar spinal canal stenosis. Forty patients who developed a new VCF were included in this study. Full-spine standing radiographs were compared before and after the fracture to examine changes in spinopelvic parameters and factors determining the changes in sagittal balance. The mean age of the patients was 79.0years. The mean interval between pre- and post-fracture radiographs was 22.7months, and the mean time between development of a fracture and post-fracture radiographs was 4.6months. After a fracture, sagittal vertical axis (SVA) increased an average of 2.78cm and spino-sacral angle (SSA) decreased an average of 5.3°. Both ⊿SVA and ⊿SSA were not related to pre-fracture parameters. The wedge angle of the fractured vertebra was not related to changes in sagittal balance. ⊿SVA increased markedly in patients with a fracture of the lower lumbar vertebrae. receiver operating characteristic analysis revealed that the relative risk of a deterioration of sagittal balance was 2.9 times higher for a new fracture below L1 than for a fracture above Th12. New VCF increased SVA by an average of 2.8cm. Sagittal balance deteriorates as a new fracture develops in the lower lumbar spine. Early intervention in osteoporosis is vital for the elderly.

Radiographic and Clinical Outcomes After Stand-Alone Anterior Lumbar Interbody Fusion for Symptomatic L5-S1 Retrolisthesis.

Degenerative lumbar spondylolisthesis is associated with significant pain and disability. The literature on the treatment options and clinical outcomes for lumbar anterolisthesis is robust, but very few reports specifically evaluate lumbar retrolisthesis. This study investigated surgical outcomes for symptomatic L5-S1 retrolisthesis treated with stand-alone L5-S1 anterior lumbar interbody fusion (ALIF). All patients with symptomatic L5-S1 retrolisthesis treated with stand-alone L5-S1 ALIF at a single institution over a 7-year period were identified. Exhaustive nonoperative management had failed for all patients. Patients with previous lumbar fusion were excluded. Preoperative and postoperative radiographic images and patient-reported outcome measures for 20 patients (14 males and 6 females; mean [SD] age, 50.3 [13.7] years) were analyzed. The mean (SD) follow-up was 43.0 (23.7) months (range, 12.1-102.5 months). Patients experienced postoperative improvements in L5-S1 retrolisthesis (P = .048), L5-S1 disk height and angle (P < .001), L5 foraminal height (P < .001), L5-S1 lordosis (P < .001), and lumbar lordosis (P = .01). There were no significant changes in spinopelvic parameters. At the most recent follow-up, minimal clinically important differences in Oswestry Disability Index score, 36-Item Short-Form Survey (SF-36), and numerical rating scale score for leg pain were achieved in 11 of 20 (55%), 7 of 14 (50%), and 7 of 13 (54%) patients, respectively. All patients demonstrated fusion with no graft subsidence at up to 32 months. No patient experienced intraoperative complications, was readmitted, or required a subsequent posterior decompression or fusion because of refractory symptoms. In our cohort, stand-alone L5-S1 ALIF was associated with radiographic and clinical improvement in patients with symptomatic L5-S1 retrolisthesis.

How does the correction in lumbar lordosis affect the spinopelvic realignments in degenerative lumbar scoliosis underwent scoliosis surgery?

BackgroundTo evaluate the effects of correction in lumbar lordosis (LL) that have on full-body realignments in patients with degenerative lumbar scoliosis (DLS) who had undergone long sacroiliac fusion surgery.MethodsA multi-center retrospective study including 88 DLS patients underwent the surgical procedure of long sacroiliac fusion with instrumentations was performed. Comparisons of radiographic and quality-of-life (QoL) data among that at the pre-operation, the 3rd month and the final follow-up were performed. The correlations between the LL correction and the changes in other spinopelvic parameters were explored using Pearson-correlation linear analysis and linear regression analysis. The correlation coefficient (r) and the adjusted r2 were calculated subsequently.ResultsAll radiographic and QoL data improved significantly (P < 0.001) after the surgical treatments. The LL correction correlated (P < 0.001) with the changes in the sacral slope (SS, r = 0.698), pelvic tilt (PT, r = -0.635), sagittal vertical axis (SVA, r = −0.591), T1 pelvic angle (TPA, r = −0.782), and the mismatch of pelvic incidence minus lumbar lordosis (PI–LL, r = −0.936), respectively. Moreover, LL increased by 1° for each of the following spinopelvic parameter changes (P < 0.001): 2.62° for SS (r2 = 0.488), −4.01° for PT (r2 = 0.404), −4.86° for TPA (r2 = 0.612), −2.08° for the PI–LL (r2 = 0.876) and -15.74 mm for SVA (r2 = 0.349). Changes in the thoracic kyphosis (r = 0.259) and pelvic femur angle (r = 0.12) were independent of the LL correction, respectively.ConclusionsLL correction correlated significantly to the changes in spinopelvic parameters; however, those independent variables including the thoracic spine and hip variables probably be remodeled themselves to maintain the full-body balance in DLS patients underwent the correction surgery.

Evaluation of changes in radiographic spinopelvic parameters after primary total hip arthroplasty and its relationship with short-term patient function.

Total hip arthroplasty (THA) is commonly used worldwide in pelvic osteoarthritis treatment. This surgery can change the spinopelvic parameters, which in turn affects the performance of the patients after surgery. However, the relationship between functional disability following THA and spinopelvic alignment is not completely understood. The limited available studies have also been conducted on the population with spinopelvic malalignments. This study aimed to examine the changes in spinopelvic parameters after primary THA in patients with normal preoperative spinopelvic characteristics and the association of these parameters with the performance, gender, and age of the patients after THA. Fifty-eight eligible patients with unilateral primary hip osteoarthritis (HOA) scheduled for total hip arthroplasty between February and September 2021 were studied. Spinopelvic parameters including pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured before surgery and three months after surgery, and the relationship between these parameters and patients' performance (Harris hip score) was assessed. Also, the relationship between the age and gender of the patients with these parameters was evaluated. The mean age of study participants was 46.03 ± 14.25. Three months after THA, sacral slope decreased with the mean difference of 4.31 ± 10.26 degrees (p = 0.002) and Harris hip score (HHS) increased by 19.41 ± 26.55 points (p < 0.001). With increasing age in patients, the mean SS and PT decreased. Among the spinopelvic parameters, SS (β = 0.11) had a greater effect than PT on postoperative HHS changes and among the demographic parameters, age (β = -0.18) had a greater effect on HHS changes than gender. Spinopelvic parameters are associated with age, gender, and patient's function after THA as sacral slope decreased and HHS increased after THA, and aging is accompanied by lowering of PT and SS.

Correlation of pelvic incidence and pelvic parameters in lumbar spondylolisthesis.

Pelvic incidence (PI) and pelvic parameters (PP) regulate the sagittal alignment of the spine and the pelvis in normal populations. Correlation of PI even more so than PP with lumbar spondylolisthesis (LS) would be useful for surgical planning. This study included 45 patients randomly selected with LS. They were divided into two groups; Group S had LS and Group C had low back pain due to other causes. All patients received lateral standing radiographs of the spine and pelvis. Based on these films, we measured the sacral slope, pelvic tilt, PI, and lumbar lordosis (LL). There were significant correlations between the PI and the sacral slope, pelvic tilt, and LL in Group S (P < 0.05). The majority of patients with LS presented with middle (60%) followed by high PIs (26.67%). Low PI was observed among just 13.33% patients with LS. Changes in spinopelvic parameters reflecting pelvic compensatory mechanisms differ depending on the extent of PI in patients with LS. In short, higher PI values correlated with more significant degrees of degenerative LS in Group S population.

Correlation Analysis of the Characteristics of Spino-Pelvic Parameters and Health-Related Quality of Life After Long-Segment Fixation for Lenke-Silva Type 5 or 6 Degenerative Scoliosis.

PurposeTo retrospectively evaluate the characteristics of spino-pelvic parameters after long-segment fixation in patients with Lenke–Silva type 5 or 6 adult degenerative scoliosis and analyze the correlation between spino-pelvic parameters and health-related quality of life (HRQL).MethodsThirty-two patients with degenerative scoliosis underwent long-segment posterior fixation were included. The spino-pelvic parameters were evaluated after surgery, and the HRQL scores were determined using the Scoliosis Research Society-22 (SRS-22), Oswestry Disability Index (ODI), and visual analog scale (VAS). Linear regression was used to analyze the correlation between changes in spino-pelvic parameters and improvements in HRQL.ResultsExcept for PI and TK, the other parameters showed significant differences after surgery (P < 0.05). All the scores of HRQL showed significant differences after surgery. The coefficient of correlation between ΔSVA and ΔVAS is 0.687 (P = 0.003), the coefficient of correlation between ΔSVA and ΔODI is 5.828 (P < 0.001). The coefficient of correlation between ΔLL and ΔVAS is −0.089 (P < 0.001), the coefficient of correlation between ΔLL and ΔODI is −1.553 (P = 0.003). The VAS score between the SVA ≥ 4cm and SVA < 4cm group have no significant difference, but have a significant difference in ODI. In PI-LL ≥ 20°and PI-LL < 20°group, the VAS and ODI all have a significant difference between the two groups.ConclusionSVA and LL have an important role in maintaining the overall balance of the spine and closely related to the postoperative HRQL, better HRQL may be achieved by reducing SVA and increasing LL. Good preoperative design will help achieve the best clinical efficacy.

The Impact of Surgical Approach on Sagittal Plane Alignment in Patients Undergoing One- or Two- Level Fusions for Degenerative Pathology: A Multicenter Radiographic Evaluation 6 Months Following Surgery

Interbody fusion procedures, including transforaminal (TLIF), posterior (PLIF), anterior (ALIF), and lateral (LLIF), effectively treat lumbar degenerative pathology and provide spinopelvic balance. The objective of this study is to compare changes in spinopelvic parameters 6 months following 1-2 level TLIF, PLIF, ALIF, and LLIF. This retrospective study included 18 centers across the United States. Patients were included in the study if they underwent a 1- or 2-level primary lumbar fusion for degenerative pathology. Preoperative and 6-month postoperative lumbar anteroposterior and lateral lumbar plain radiograph measurements included: pelvic incidence, pelvic tilt, lumbar lordosis from L1-S1, and segmental lordosis of each segment between L1 and S1. A total of 474 patients met inclusion criteria, with 632 levels that underwent fusion. Of these, 181 patients underwent an ALIF/LLIF on 381 levels, and 188 underwent a TLIF/PLIF on 252 levels. ALIF/LLIF procedures resulted in significantly more segmental lordosis (P<0.001) and global lumbar lordotic alignment change (P< 0.01) compared with TLIF/PLIF procedures. Whether patients' alignment was preserved versus worsened was not significantly predicted by type of procedure. Similarly, whether patients' alignment was restored versus not corrected was not significantly predicted by procedure. In this large-scale multicenter study of lumbar fusion patients presenting with degenerative lumbar pathology, anteriorly placed grafts (ALIF/LLIF) led to a greater likelihood of patients being preserved rather than worsened in their spinopelvic mismatch. Posteriorly placed TLIF or PLIF grafts tended to worsen lordosis both segmentally and globally, yet even the anterior grafts only modestly improved those 2 same measurements.

A comparison of long-term efficacy of K-rod-assisted non-fusion operation and posterior lumbar interbody fusion for single-segmental lumbar disc herniation

K-rod-assisted non-fusion surgery for the treatment of lumbar disc herniation has been proven to have short-term clinical efficacy. Meanwhile, its long-term effects have not been examined. To observed the long-term clinical efficacy of K-rod-assisted non-fusion operation, this study retrospectively analyzed 22 patients with lumbar disc (L4/5) herniation who underwent K-rod-assisted non-fusion operation (n = 13) or PLIF (n = 9). They were followed-up for more than 5 years. The operation times and blood loss were significantly reduced in the K-rod group compared to the PLIF group. At the last follow-up, the clinical outcomes of the K-rod group were improved compared to those of the PLIF group as observed by the VAS score, JOABPEQ, and ODI. Imaging outcomes at the last follow-up indicated that the loss of height in the L3/4 and L5/S1 intervertebral space, the ROM of L3/4 and L5/S1, and the incidence of adjacent segment degeneration in the PLIF group were significantly higher than those in the K-rod group. According to Pfirrmann grading, Modic changes, and UCLA grading, the incidence of adjacent segment degeneration was 55.6% in the PLIF group and 15.4% in the K-rod group. Changes in spino-pelvic parameters between the two groups were as follows: pelvic index remained unchanged, pelvic tilt angle increased, and lumbar lordosis and sacral slope decreased. Therefore, compared to PLIF, single-segment lumbar disc herniation using K-rod-assisted non-fusion surgery resulted in better long-term clinical efficacy. Our results demonstrate that this procedure can delay adjacent segment degeneration after lumbar surgery.

Correlation of Paraspinal Muscle Mass With Decompensation of Sagittal Adult Spinal Deformity After Setting of Fatigue Post 10-Minute Walk.

ObjectiveThe purpose of this study was to investigate the changes in spinopelvic parameters before and after the setting of muscle fatigue along with its correlation with pre-existing paraspinal and psoas muscle mass. MethodsSingle-center retrospective review of prospectively collected data was conducted on 145-adults with symptomatic loss of lumbar lordosis (LL). Radiographs were taken before and after walking for 10 minutes. Magnetic resonance imaging was used to calculate paraspinal muscle (PSM) cross-sectional area (CSA), mean signal intensity, fatty infiltration (FI), and lean muscle mass at thoracolumbar junction (T12) and lower lumbar level (L4). Psoas CSA was calculated at L3. Patients were divided into 2 groups namely compensated sagittal deformity (CSD) (SVA≤4 cm, PT>20°) and decompensated sagittal deformity (DSD) (SVA>4 cm, PT>20°) based on prewalk measurements. ResultsInitial mean SVA was 1.8 cm and 11 cm for CSD and DSD respectively (p < 0.01). After walking, significant deteriorations in SVA, PT–LL (p < 0.01) were observed in CSD without significant change in thoracic kyphosis (TK). All sagittal parameters in DSD deteriorated significantly. DSD group had significantly poorer PSM quality at T12 and L4 compared to CSD group. In CSD group, sagittal decompensation correlated with muscle quality, i.e., decreases in LL (ΔLL) correlated with CSA of PSM/vertebral body (VB) at L4 (r=-0.412, p=0.046) while increases in TK (ΔTK) correlated with CSA of PSM/VB at T12 (r=0.477, p=0.018). ΔSVA and ΔPT correlated with FI at L4 (r=0.577, p=0.003 and r=-0.407, p=0.048, respectively). DSD group, had weak correlations (-0.3<r<-0.1) between changes in sagittal and PSM parameters. ConclusionPSM quality in adults with spinal deformity correlates with patients’ ability to maintain an upright posture and sagittal decompensation after walking for 10 minutes.

Association of Sagittal Spinopelvic Realignment with Correction in Lower Lumbar Lordosis after Surgical Treatment in Degenerative Lumbar Scoliosis.

ObjectiveTo assess the effect that correction of lower lumbar lordosis (3L) has on global spine realignment due to the key role of 3L for scoliosis surgery in patients with degenerative lumbar scoliosis (DLS).MethodsThis study is a retrospective review performed between June 2018 and January 2020, including consecutive patients with DLS. Only patients age ≥ 45 years who had already undergone a selective root block operation and had the procedure of long‐fusion extending to pelvis and posterior lumbar interbody fusion (PLIF) at lower lumbar spine (L4‐S1) were retained for analysis. Spinopelvic parameters measured included thoracic kyphosis (TK), lumbar lordosis (LL), 3L, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), T1 pelvic angle (TPA), and sagittal vertical axis (SVA) at pre‐operation and the third month follow‐up. The mismatch (PI‐LL) was calculated subsequently. Pearson correlation and linear regression analysis were performed to explore the association of the changes in global spinopelvic parameters with 3L correction.ResultsThirty‐nine patients (five males, 34 females) with the average age of 63.84 years (SD 7.53; range, 45–75 years) at the time of surgery were identified. All patients had the surgical procedure of long‐fusion (≥4 vertebras) with PLIF at lower lumbar spine between L4 and S1 spine. Lower instrumented vertebras (LIV) fused to pelvis (S1, 14; S2, 18; ilium, 7) were operated in all patients. Seventeen patients were with upper instrumented vertebras (UIV) at thoracolumbar spine (L2‐T11), and 22 patients at thoracic spine (T10 and above). The median of instrumented segments was 10 (5–14). 3L significantly increased (P = 0.02) after surgical treatment by mean change of 4.21° (range, −19.7° to +22.2°). Perioperatively, all spinopelvic parameters regarding to TK, LL, SS, PT, TPA, SVA, and mismatch (PI‐LL) had significant changes (P < 0.001). The change in 3L correlated significantly with the changes in spinopelvic parameters (r = 0.772 for LL, −0.589 for SVA, −0.439 for TPA, and −0.428 for PI‐LL). After linear regression analysis, the formulas were obtained: d‐LL = 14.977 + 0.636 × d‐3L, (R 2 = 0.596); d‐(PI‐LL) = 16.575 + 0.62 × d‐3L, (R 2 = 0.183); d‐TPA = −7.284 to 0.358 × d‐3L, (R 2 = 0.193); d‐SVA = −30.556–2.639 × d‐3L (R 2 = 0.347).ConclusionsCorrection in lower lumbar lordosis, following the surgical procedure of long‐fusion with PLIF at lower lumbar spine, could result in significant changes in full‐spine parameters. The significant association of changes in each of global spine parameter with the correction of 3L perioperatively could provide important information for surgeons to make a surgical plan for spinal correction.

New Onset Sacroiliac Joint Pain After Transforaminal Interbody Fusion: What Are the Culprits?

A retrospective case-control study. Only a few studies have studied the incidence of new-onset SI joint pain following lumbar spine fusion surgery. We aimed to explore the association between new-onset SI joint pain following Transforaminal Lumbar Interbody Fusion (TLIF) for degenerative spine disorders and changes in spinopelvic parameters. A retrospective review of hospital records and imaging database of a tertiary care institute was done for patients who underwent TLIF from October 2018 to October 2019. The 354 patients who satisfied the eligibility criteria were divided into 2 groups(Group A, new-onset SI joint pain group, n = 34 and Group B, normal controls, n = 320). Symptomatic relief (>70% reduction in the VAS [Visual Analogue Scale] score) after 15 minutes of SI joint injection was considered diagnostic of SI joint pain. Clinical and radiological spinopelvic parameters were compared between the 2 groups. Patients with postoperative SI joint pain (Group A) had significantly less preoperative and postoperative lumbar lordosis (p < 0.001) compared to the other group. Most of the patients in Group A had a cephalad migration of the apex postoperatively (30/34 patients) whereas majority of patients in group B had either predominant caudal migration (44/320 patients) or no migration of the lumbar apex (272/320 patients). The preoperative and postoperative lumbar lordosis are significantly less and the postoperative pelvic tilt is significantly high in patients with new-onset SI joint pain compared to the control group. The cephalad migration of the lumbar apex is significantly associated with new-onset SI joint pain.

Clinical and radiological outcome analysis among patients with spondylitis tuberculosis of the lumbar vertebrae after correction and posterior instrumentation in cipto mangunkusumo and Fatmawati Hospital in 2018–2020: A cross sectional study

IntroductionSpondylitis tuberculosis can cause changes in spinopelvic parameters including pelvic incidence, pelvic tilt, and sacral slope due to biomechanical changes of the spine. Posterior instrumentation is one of the modality for the treatment of spondylitis tuberculosis. However, in Indonesia, clinical and radiological outcomes after posterior instrumentation in tuberculosis of lumbar vertebrae are still rare. This study aims to investigate the clinical and radiological outcomes of patients with spondylitis tuberculosis of the lumbar vertebrae after posterior instrumentation. MethodThis study was a cross-sectional study in patients with spondylitis tuberculosis of the lumbar vertebrae who underwent posterior instrumentation in Cipto Mangunsukumo and Fatmawati Hospital. Subjects were collected through consecutive sampling. 23 subjects were collected and analyzed. Clinical and radiological outcomes before and after posterior instrumentation were compared. The clinical outcome included the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). The radiological outcome included sacral slope, pelvic tilt, pelvic incidence, and lumbar lordosis. ResultsThe median age of the subjects was 31 (9–57) years with a female-majority (60,9%). The median of the total vertebral infected was 2 (1–4). Median of VAS score before surgery, 6 months after surgery, and 12 months after surgery were 9 (4–10), 4 (1–7), dan 2 (1–6) (p < 0,001) consecutively. Median of ODI score before surgery, 6 months after surgery, and 12 months after surgery were 70 (40–86), 34 (10–74), dan 12 (2–74) (p < 0,001) consecutively. There was no significant difference in spinopelvic parameters before and after the surgery. The difference of ODI score before and after the surgery inversely correlated with the difference of lumbar lordotic and sacral slope. ConclusionPosterior instrumentation could improve clinical outcomes in patients with spondylitis tuberculosis of the lumbar. Change of lumbar lordotic and sacral slope after posterior instrumentation led to an improvement of quality of life marked by the reduction of the ODI score.

Impact of Spinal Correction Surgeries with Osteotomy and Pelvic Fixation in Patients with Kyphosis Due to Osteoporotic Vertebral Fractures.

Study DesignCombination of retrospective and prospective study.PurposeWe aimed to compare the clinical outcomes between local fixation surgery and spinopelvic fixation surgery for the treatment of kyphosis secondary to osteoporotic vertebral fractures with spinopelvic malalignment.Overview of LiteratureThe clinical characteristics of patients with rigid kyphosis due to osteoporotic vertebral fracture differ from that of middle-aged patients with vertebral fractures in terms of bone fragility and presence of spinopelvic malalignment. Little is known about the surgical strategies for these deformities, most especially the extent of fusion of vertebra involved.MethodsWe analyzed 24 patients with vertebral osteotomy at the level of the fracture and spinal fixation without pelvic fixation (local group), and 22 patients with vertebral osteotomy and pelvic fixation (pelvic group). Radiographic parameters, the incidence of proximal junctional kyphosis (PJK), distal junctional kyphosis (DJK), rod fractures, and the Oswestry Disability Index (ODI) were compared between the two groups over a 2-year follow-up period.ResultsIn the pelvic group, postoperative spinopelvic parameters significantly improved, with the improvements maintained. No remarkable changes in spinopelvic parameters were seen in the local group. The mean ODI scores 2 years after surgery were 45.3 and 33.0 in the local and pelvic group, respectively (p-value <0.05). There was no significant difference in the incidence of PJK in the local and pelvic groups, but there was a higher rate of DJK (41.7%) in the local group. In contrast, rod fractures were more common in the pelvic group (45.5%). Patients with DJK had higher ODI scores 2 years after surgery (52.0 in DJK patients vs. 34.8 in non-DJK patients; p-value <0.05).ConclusionsFor patients with rigid kyphosis due to osteoporotic vertebral fractures, better spinopelvic alignment and health-related quality of life can be achieved through extensive corrective surgery with pelvic fixation.

Reciprocal Changes in Cervical Alignment After Thoracolumbar Arthrodesis for Adult Spinal Deformity.

Multicenter database review of consecutive adult spinal deformity (ASD) patients. The aim of this study was to identify associations between changes in spinopelvic parameters and cervical alignment after thoracolumbar arthrodesis for ASD. Reciprocal cervical changes occur after instrumented thoracic spinal arthrodesis. The timing and relationship of these changes to sagittal alignment and upper instrumented vertebra (UIV) selection are unknown. In 171 ASD patients treated with thoracolumbar arthrodesis from 2008 to 2012, we assessed changes from baseline to 6-week, 1-year, and 2-year follow-up in C2-C7 sagittal vertical axis (SVA), T1 slope, and C2-C7 lordosis. We used multivariate models to analyze associations between these parameters and UIV selection (T9 or distal vs. proximal to T9) and changes at each time point in thoracic kyphosis (TK), lumbar lordosis (LL), C7-S1 SVA, pelvic incidence, pelvic tilt, and sacral slope. Two-year changes in C2-C7 SVA and T1 slope were significantly associated with baseline to 6-week changes in TK and LL and with UIV selection. Baseline to 2-year changes in C2-C7 lordosis were associated with baseline to 6-week changes in C7-S1 SVA (P = 0.004). Most changes in C2-C7 SVA occurred during the first 6 weeks postoperatively (mean 6-week change in C2-C7 SVA: 2.7 cm, 95% confidence interval [CI]: 0.7-4.7 cm; mean 2-year change in SVA: 2.3 cm, 95% CI: -0.1 to 4.6 cm). At 2 years, on average, there was decrease in C2-C7 lordosis, most of which occurred during the first 6 weeks postoperatively (mean 6-week change: -3.2°, 95% CI: -4.8° to -1.2°; mean 2-year change: -1.3°, 95% CI: - 3.2° to 0.5°). After thoracolumbar arthrodesis, reciprocal changes in cervical alignment are associated with postoperative changes in TK, LL, and C7-S1 SVA and with UIV selection. The largest changes occur during the first 6 weeks and persist during 2-year follow-up. 3.