Sagittal Spinopelvic Parameters Research Articles

Do spinopelvic parameters affect the severity of thoracolumbar trauma differently between in-vehicle traffic accidents and falling from a height?

Objective: Although there is a comprehensive characterization of the impact of spinopelvic parameters on outcomes after degenerative spine surgery, the impact of spinopelvic parameters on thoracolumbar trauma has not yet been defined. In the present study, it was aimed to reveal the correlation between the severity of vertebral fractures developing after trauma according to the mechanism of occurrence and sagittal spinopelvic parameters. Materials and methods: Patients with thoracolumbar vertebra fractures were evaluated retrospectively. The patients were divided into two groups: in-vehicle traffic accident (sitting group) and fall from height (standing group). The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and vertebral Hounsfield unit (HU) values were measured on computed tomography (CT) scans. Results: The results of the multivariate logistic regression analysis performed in the study revealed that a one-unit increase in PI reduced the risk of more comminuted fractures (A2 and above) by 0.90 times in sitting position trauma (Hazard ratio (HR): 0.90; 95% CI: 0.84–0.96; p=0.002) and by 0.96 times in standing position trauma (HR: 0.96; 95% CI: 0.93–0.99; p=0.040). Conclusions: It was observed that in vertebral fractures developed after trauma, the fact that the vertebral column of patients with low PI is more rigid increased the severity of the fracture.

Determining the vertebra for pedicle subtraction osteotomy in surgical correction for ankylosing spondylitis with thoracolumbar kyphosis

OBJECTIVE This study aimed to provide a method for determining the apical vertebra for pedicle subtraction osteotomy (PSO) in corrective surgery for patients with ankylosing spondylitis (AS) with thoracolumbar kyphosis (TLK). METHODS The medical records of AS patients with TLK who underwent PSO between May 2009 and August 2022 were retrospectively reviewed, and 235 patients were included in the study. Using the proposed method, choosing the vertebra based on Kim’s apex (KA), which is defined as the farthest vertebra from a line drawn from the center of the T10 vertebral body to the midpoint of the S1 upper endplate, the authors analyzed 229 patients with apices at T12, L1, or L2 (excluding L3 because of the small sample size, n = 6). They divided all patients into two groups. Group A (n = 144) underwent PSO at the KA vertebra, while group B (n = 85) underwent PSO at a different level. Demographic and radiological data, including sagittal spinopelvic parameters of the entire spine, were collected. An additional analysis was performed on patients with the same KA vertebra. RESULTS The vertebra distributions of patients based on KA were T12 (28 [12.2%]), L1 (119 [52.0%]), and L2 (82 [35.8%]). The corrections of sagittal vertical axis (SVA; 101.0 ± 48.5 mm vs 82.0 ± 53.8 mm, p = 0.010), global kyphosis (GK; 31.6° ± 10.0° vs 26.4° ± 10.5°, p = 0.005), and TLK (29.4° ± 10.2° vs 24.2° ± 12.9°, p = 0.012) in group A were significantly greater than those in group B, and there was no difference in the corrections of thoracic kyphosis (TK), lumbar lordosis, and pelvic incidence between the two groups. On further analysis, group A showed greater correction in TK (26.2° ± 13.7° vs 0.1° ± 8.1°, p = 0.013) for patients with T12 as the KA; greater improvements in SVA (101.5 ± 44.2 mm vs 73.4 ± 48.7 mm, p = 0.020), GK (30.6° ± 11.0° vs 25.0° ± 10.4°, p = 0.046), and TLK (32.6° ± 7.8° vs 26.7° ± 9.9°, p = 0.012) for those with L1 as the KA; and significant correction in TLK (30.0° ± 6.3° vs 4.3° ± 19.5°, p = 0.008) for patients with L2 as the KA, compared with group B. CONCLUSIONS PSO at the apical vertebra provides a greater degree of correction of sagittal imbalance. The proposed method, selecting the vertebra based on KA, is easily reproducible for determining the apex level in AS patients with TLK.

Spinopelvic morphology impacts on postoperative proximal junctional kyphosis in congenital scoliosis with thoracolumbar hemivertebrae.

It aims to investigate the lumbar and pelvic morphology in congenital scoliosis with thoracolumbar hemivertebrae and its impact on proximal junctional kyphosis (PJK) incidence after hemivertebra resection and short fusion. 23 congenital scoliosis patients with thoracolumbar hemivertebra aged between 10 and 18years were enrolled in the retrospective study. Spinopelvic sagittal parameters were analyzed on whole-spine standing lateral radiographs preoperatively, one-week postoperatively and at the final follow-up. Pearson correlations were calculated for local kyphosis (LK), lumbar and pelvic morphology parameters. Binary logistic regression and receiver operating characteristics (ROC) curve analysis were performed to identify the risk factors for PJK. Thoracolumbar hemivertebra caused LK of 29.2° ± 17.3°, an increased lumbar lordosis (LL) (-64.7° ± 16.3°), lower LL apex (52.2% at L5), and small pelvic incidence (PI) (36.8° ± 6.6°). LK was correlated with lumbar morphology parameters, including LL (r = -0.837), upper arc of LL (LLUA) (r = -0.879), thoracolumbar kyphosis (TLK) (r = 0.933), thoracic kyphosis (TK) (r = 0.762) and TK apex (TKA) (r = -0.749). Surgical treatment improved the lumbar morphology, but not pelvic morphology. At the final follow-up, LL had returned to its preoperative value (p = 0.158). PJK occurred in 30.4% of cases as a compensatory mechanism. Preoperatively, significant differences of parameters between non-PJK and PJK groups were observed in LK and TLK. Binary logistic regression identified three independent risk factors for PJK: preoperative LLA (OR = 0.005, 95%CI = 0.000-0.287, p = 0.011), preoperative TLK (OR = 1.134, 95%CI = 1.001-1.286, p = 0.048), and preoperative lumbar lordosis morphology type (OR = 5.507, 95%CI = 1.202-25.227, p = 0.028). However, residual LK after surgery was not correlated with PJK incidence. ROC curve analysis verified that preoperative TLK > 22.59° was associated with increased PJK incidence after surgery. Lumbar morphology changes as a compensatory mechanism beneath the thoracolumbar hemivertebra. However, a stable pelvis tends to allow the LL to return to its preoperative value. PJK occurred as a cranial compensatory mechanism for increasing LL and corrected TLK. A larger TLK (> 22.59°) was an independent risk factor for PJK incidence in patients with type 2 and 3A lumbar lordosis morphology.

The Influence of Radiographic Parameter on the S2 Alar-Iliac Screw Virtual Trajectory in Degenerative Lumbar Scoliosis Patients: A Computed Tomography Study.

S2 alar-iliac (S2AI) screw had been widely used in the pelvic fusion for degenerative lumbar scoliosis (DLS) patients. However, whether S2AI screw trajectory was influenced by sagittal profile in DLS patients had not been comprehensively investigated. The objective of this study was to evaluate the associations between the optimal S2 alar-iliac (S2AI) screw trajectory and sagittal spinopelvic parameters in DLS patients. Computed tomography (CT) scans of pelvis were performed in 47 DLS patients for three-dimensional reconstruction of S2AI screw trajectory from September 2019 to November 2021. Five S2AI screw trajectory parameters were measured in CT reconstruction images, including: 1) angle in the transverse plane (Tsv angle); 2) angle in the sagittal plane (Sag angle); 3) maximal screw length; 4) screw width; and 5) skin distance. The lumbar Cobb angle, lumbar apical vertebral translation (AVT); global kyphosis (GK); thoracic kyphosis (TK); lumbar lordosis (LL); sagittal vertical axis (SVA); sacral slope (SS); pelvic tilt (PT); and pelvic incidence (PI) were measured in standing X-ray films of the whole spine and pelvis. Both Tsv angle and Sag angle had significant positive associations with SS (p < 0.05) but negative associations with both PT (p < 0.05) and LL (p < 0.05) in all cases. Patients with SS less than 15° had both smaller Tsv angle and Sag angle than those with SS equal to or more than 15° (p < 0.05). The decreased LL would lead to the backward rotation of the pelvis, resulting in a more cephalic and less divergent trajectory of S2AI screw in DLS patients. For DLS patients with lumbar kyphosis, spine surgeons should avoid both excessive Tsv and Sag angles for S2AI screw insertion, especially when using free-hand technique.

Does Periacetabular Osteotomy Change Sagittal Spinopelvic Alignment?

There are few data on the impact of periacetabular osteotomy (PAO) on sagittal spinopelvic alignment. Prior studies have attempted to delineate the relationship by performing measurements on AP radiographs and using mathematical models to determine changes in postoperative pelvic tilt. This information is clinically significant to a surgeon when evaluating acetabular/pelvic position intraoperatively and understanding spinopelvic alignment changes postoperatively; therefore, radiographic changes from PAO should be described in more detail. In this study, we asked: (1) Does the performance of PAO result in consistent changes in spinopelvic alignment, as measured on EOS radiographs? (2) Does this differ for unilateral versus bilateral PAOs? (3) Does this differ in the setting of a mobile spine versus an immobile spine? (4) Does this differ based on preoperative pelvic tilt? Mean preoperative and at least 1-year postoperative (15 ± 8 months from surgery, minimum 11 months, maximum 65 months) EOS hip-to-ankle standing and sitting radiographs for 55 patients in a prospectively collected registry who underwent PAO with a single surgeon from January 1, 2019, to January 11, 2022, were measured for pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, lateral center-edge angle, L1 pelvic angle, and pubic symphysis to the sacroiliac index. Normality was assessed and paired sample t-tests (normally distributed data) or Wilcoxon signed rank tests (not normally distributed data) were utilized to assess if any measurements changed from preoperative to postoperative. Patients were then divided based on whether they had unilateral or bilateral dysplasia and unilateral or bilateral surgery, and these subgroups were analyzed the same way as the entire cohort. Two more subgroups were then formed based on lumbar mobility, defined as a change in sitting-to-standing lumbar lordosis less or greater than 1 SD from the population mean preoperatively, and the subgroups were analyzed the same way as the entire cohort. Finally, two additional subgroups were formed, preoperative standing pelvic tilt less than 10° and more than 20°, and analyzed the same as the entire cohort. For the entire cohort, the median (IQR) standing lateral-center edge angle increased 17°, from a median of 21° (10°) to a median of 38° (8° [95% confidence interval (CI) 16° to 20°; p < 0.001). The median sitting lateral center-edge angle increased 17°, from a median of 18° (8°) to a median of 35° (8° [95% CI 14° to 19°]; p < 0.001). Standing pelvic incidence increased from 50° ± 11° to 52° ± 12° (mean difference 2° [95% CI 1° to 3°]; p = 0.004), but there were no changes for other measured parameters. There were no changes in any of the spinopelvic parameters for patients with unilateral dysplasia receiving a unilateral PAO, but patients with bilateral dysplasia who underwent bilateral PAOs demonstrated an increase in pelvic incidence from 57° (14°) to 60° (16°) (95% CI 1° to 5°; p = 0.02) and a decrease in pubic symphysis to sacroiliac index from 84 mm (24 mm) to 77 mm (23 mm) (95% CI -7° to -2°; p = 0.007). Patients with mobile lumbar spines preoperatively did not exhibit any changes in sagittal spinopelvic alignment, but patients with immobile lumbar spines preoperatively experienced several changes after surgery. Patients with less than 10° of standing pelvic tilt demonstrated a median (IQR) 2° increase in pelvic incidence from median 43° (9°) to 45° (12° [95% CI 0.3° to 4°]; p = 0.03), but they did not experience any other changes in sagittal spinopelvic alignment parameters postoperatively. Patients with preoperative pelvic tilt more than 20° did not experience any change in sagittal spinopelvic parameters. PAO increases pelvic incidence, potentially because of anterior translation of the hip center. There were no changes in other spinopelvic parameters postoperatively except after bilateral PAO. Additionally, patients lacking spine mobility preoperatively, indicated by a minimal change in lumbar lordosis between standing and sitting positions, may experience several changes in spinopelvic alignment, including increased mobility of their spine after PAO. This may be because of decreased compensatory spine splinting after increasing acetabular coverage, but further research including patient-reported outcomes is warranted. Level III, therapeutic study.

Impact of the sagittal spinopelvic and coronal lower extremity alignments on clinical outcomes after medial unicompartmental knee arthroplasty

IntroductionWe evaluated whether the clinical outcomes, including postoperative knee range of motion (ROM), after unicompartmental knee arthroplasty (UKA) were associated with the sagittal spinopelvic parameters and coronal alignment of the full lower extremity. MethodsForty-two patients (50 knees: six men, seven knees; 36 women, 43 knees) who underwent medial UKA between April 2015 and December 2022 were included. Preoperative radiographic examinations of the index for sagittal spinopelvic alignment included the sagittal vertical axis (SVA), lumbar lordosis, sacral slope (SS), pelvic tilt (PT), and pelvic incidence. The anteroposterior hip-knee-ankle angle (HKAA) was calculated. The relationship of clinical outcomes and the risk of knee flexion angle ≤125° and knee flexion contracture ≥10° 1-year post-UKA with radiographic parameters were evaluated. ResultsPreoperative HKA angle affected postoperative knee flexion angle ≤125° (p = 0.017, 95% confidence interval [CI]: 0.473–0.930) in logistic regression analysis. Patients with a knee flexion angle ≤125° had a higher preoperative HKAA (9.8 ± 3.0°), higher SVA (83.8 ± 37.0 mm), and lower SS (23.7 ± 9.0°) than those with a flexion angle >125° (preoperative HKAA: 6.6 ± 4.0°, SVA: 40.3 ± 46.5 mm, SS: 32.0 ± 6.3°) (p = 0.029, 0.012, and 0.004, respectively). PT related to postoperative knee flexion contracture ≥10° (p = 0.010, 95% CI: 0.770–0.965) in the logistic regression analysis. Patients with flexion contracture ≥10° had higher PT (35.0 ± 6.6°) and SVA (82.2 ± 40.5 mm) than those with flexion contracture <10° (PT, 19.3 ± 9.0°; SVA, 42.4 ± 46.5 mm) (p = 0.001 and 0.028, respectively). The postoperative clinical outcome was correlated with the postoperative knee flexion angle and SVA (p = 0.036 and 0.020, respectively). ConclusionsThe preoperative HKAA affected postoperative knee flexion angle, and the knee flexion contracture and clinical outcomes post-UKA were associated with PT and SVA, respectively. To predict outcomes for knee ROM and clinical scores after UKA, radiographic examination, including the sagittal spinopelvic parameters and the coronal view of the full lower extremity, is essential.

Sagittal alignment of diverse mechanical complications following adult spinal deformity surgery.

To compare the sagittal alignment of patients with diverse mechanical complications (MCs) following adult spinal deformity (ASD) surgery with that of patients without MCs. A total of 371 patients who underwent ASD surgery were enrolled. The sagittal spinopelvic parameters were measured preoperatively and at the 6-month and last follow-up, and the global alignment and proportion (GAP) score was calculated. The subjects were divided into non-MC and MCs groups, and the MCs group was further divided into rod fracture (RF), screw breakage (SB), screw dislodgement (SD) and proximal junctional kyphosis (PJK) subgroups. Preoperatively, the RF group had greater thoracolumbar kyphosis (TLK) and relative upper lumbar lordosis (RULL); the SB group had the largest pelvic incidence (PI) and lumbar lordosis (LL); the SD group had the least global sagittal imbalance; and the PJK group had the highest thoracic kyphosis (TK), TLK and RULL. At the last follow-up, the RF and SB groups featured a large PI minus LL (PI-LL), while the PJK group featured a prominent TK; all the MCs subgroups had sagittal malalignment and a higher GAP score, and the SB group had the most severe cases. Logistic regressions showed that the relative spinopelvic alignment (RSA) score was correlated with RF, SB and SD, while the RSA and age scores were associated with PJK. Each patient with MCs had individual characteristics in the sagittal plane following ASD surgery, which may be helpful to understand the pathophysiology of poor sagittal alignment with its subsequent MCs and guide an eventual revision strategy.

Development of ethnicity-adjusted global alignment and proportion score to predict the risk of mechanical complications following corrective surgery for adult spinal deformity

BACKGROUND CONTEXTSurgery for degenerative scoliosis (DS) is a complex procedure with high complication and revision rates. Based on the concept that pelvic incidence (PI) is a constant parameter, the global alignment and proportional (GAP) score was developed from sagittal alignment data collected in the Caucasian populations to predict mechanical complications. However, the PI varies among different ethnic groups, and the GAP score may not apply to Chinese populations. Thus, this study aims to assess the predictability of the GAP score for mechanical complications in the Chinese populations and develop an ethnicity-adjusted GAP score. PURPOSETo test the predictability of the original GAP score in the Chinese population and develop a Chinese ethnicity-tailored GAP scoring system. STUDY DESIGN/SETTINGSRetrospective cohort study. PATIENT SAMPLEA total of 560 asymptomatic healthy volunteers were enrolled to develop Chinese ethnicity-tailored GAP (C-GAP) score and a total of 114 DS patients were enrolled to test the predictability of original GAP score and C-GAP score. OUTCOME MEASURESDemographic information, sagittal spinopelvic parameters of healthy volunteers and DS patients were collected. Mechanical complications were recorded at a minimum of 2-year follow-up after corrective surgery for DS patients. METHODSA total of 560 asymptomatic healthy volunteers with a mean age of 61.9±14.1 years were enrolled to develop ethnicity-adjusted GAP score. Besides, 114 surgically trated DS patients (M/F=10/104) with a mean age of 60.7±7.1 years were retrospectively reviewed. Demographic data and radiological parameters of both groups, including PI, lumbar lordosis (LL), sacral slope (SS), the sagittal vertical axis (SVA), and global tilt (GT) were collected. Ideal LL, SS, and GT were obtained by calculating their correlation with PI of healthy volunteers using linear regression analysis. Relative pelvic version (RPV), relative lumbar lordosis (RLL), lordosis distribution index (LDI), and relative spinopelvic alignment (RSA) were obtained using the ideal parameters, and the Chinese population adjusted GAP score (C-GAP) was developed based on these values. The predictability of original and C-GAP for mechanical failure was evaluated using clinical and radiological data of DS patients by evaluating the area under the curve (AUC) using receiver operating characteristic curve. This study was supported the National Natural Science Foundation of China (NSFC) (No. 82272545), ($ 8,000–10,000) and the Jiangsu Provincial Key Medical Center, and the China Postdoctoral Science Foundation (2021M701677), Level B ($ 5,000–7,000). RESULTSIdeal SS=0.53×PI+9 (p=.002), ideal LL=0.48×PI+22 (p=.023) and ideal GT=0.46 × PI-9 (p=.011). were obtained by correlation analysis using sagittal parameters from those healthy volunteers, and RPV, RLL, RSA, and LDI were calculated accordingly. Then, the ethnicity-adjusted C-GAP score was developed by summing up the numeric value of calculated RPV, RLL, RSA, and LDI. The AUC was classified as ‘‘no or low discriminatory power’’ for the original GAP score in predicting mechanical complications (AUC=0.592, p=.078). Similarly, the original GAP score did not correlate with mechanical complications in DS patients. According to the C-GAP score, the sagittal parameters were proportional in 25 (21.9%) cases, moderately disproportional in 68 (59.6%), and severely disproportional in 21% (18.5%) cases. The incidence of mechanical complications was statistically different among proportioned and moderately disproportional and severely disproportional portions of the C-GAP score (p=.03). The predictability of the C-GAP score is high with an AUC=0.773 (p<.001). In addition, there is a linear correlation between mechanical complication rate and C-GAP score (χ=0.102, p=.02). CONCLUSIONThe Ethnicity-adjusted C-GAP score system developed in the current study provided a more accurate and reliable for predicting the risk of mechanical complications after corrective surgery for adult spinal deformity.

THE KNEE-HIP-SPINE TRILEMMA IN PATIENTS WITH SEVERE CONGENITAL DYSPLASIA OF THE HIP UNDERGOING TOTAL HIP ARTHROPLASTY: 77 HIPS FOLLOWED UP FOR A MINIMUM OF FIVE YEARS

Pelvic bone defect in patients with severe congenital dysplasia of the hip (CDH) lead to abnormalities in lumbar spine and lower limb alignment that can determine total hip arthroplasty (THA) patients' outcome. These variables may be different in uni- or bilateral CDH.We compared the clinical outcome and the spinopelvic and lower limb radiological changes over time in patients undergoing THA due to uni- or bilateral CHD at a minimum follow-up of five years.Sixty-four patients (77 hips) undergoing THA due to severe CDH between 2006 and 2015 were analyzed: Group 1 consisted of 51 patients with unilateral CDH, and group 2, 113 patients (26 hips) with bilateral CDH. There were 32 females in group 1 and 18 in group 2 (p=0.6). The mean age was 41.6 years in group 1 and 53.6 in group 2 (p&lt;0.001). We compared the hip, spine and knee clinical outcomes. The radiological analysis included the postoperative hip reconstruction, and the evolution of the coronal and sagittal spinopelvic parameters assessing the pelvic obliquity (PO) and the sacro-femoro-pubic (SFP) angles, and the knee mechanical axis evaluating the tibio-femoral angle (TFA).At latest follow-up, the mean Harris Hip Score was 88.6 in group 1 and 90.7 in group 2 (p=0.025). Postoperative leg length discrepancy of more than 5 mm was more frequent in group 1 (p=0.028). Postoperative lumbar back pain was reported in 23.4% of the cases and knee pain in 20.8%, however, there were no differences between groups. One supracondylar femoral osteotomy and one total knee arthroplasty were required. The radiological reconstruction of the hip was similar in both groups. The PO angle improved more in group 1 (p=0.01) from the preoperative to 6-weeks postoperative and was constant at 5 years. The SFP angle improved in both groups but there were no differences between groups (p=0.5). 30 patients in group 1 showed a TFA less than 10º and 17 in group 2 (p=0.7).Although the clinical outcome was better in terms of hip function in patients with bilateral CDH than those with unilateral CDH, the improvement in low back and knee pain was similar. Patients with unilateral dysplasia showed a better correction of the PO after THA. All spinopelvic and knee alignment parameters were corrected and maintained over time in most cases five years after THA.

Patient-specific spinal rods in adult spinal deformity surgery reduce proximal junctional failure: a review of patient outcomes and surgical technique in a prospective observational cohort.

Spinal rods used for adult spinal deformity (ASD) correction are usually manufactured straight and bent manually during surgery. Pre-bent patient-specific spinal rods (PSSR) developed with software provide the surgeon with an intraoperative deformity correction consistent with the surgical plan. Our aim was to report clinical and radiological outcomes using PSSR. We investigated rates of junctional complications both proximally [kyphosis (PJK) and failure (PJF)] and distally [failure (DJF)]. Prospective case series of 20 consecutive patients who underwent ≥4 level ASD surgery with PSSR at a single institution between January 2019 and December 2022. Preoperative, 6-week, 6-month, 12-month, 24-month, and final follow-ups assessed patient satisfaction (Ottawa decision regret questionnaire) and patient reported outcome measures (PROMs) [visual analogue scale (VAS; Back/Leg), Oswestry disability index (ODI), and 12-Item Short Form Survey (SF-12)]. Sagittal spinopelvic parameters [sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence and lumbar lordosis mismatch (PI-LL)] measured by serial EOS scans were performed preoperatively then compared to planned correction and postoperative measures. Interoperative cages (narrow/wide) were placed for interbody support. PJK risk score assessed likelihood of developing kyphosis. Serial computed tomography (CT) imaging assessed complication (fusion/subsidence). The mean age of the patients (75% female) was 71.9±6.9 years, and the mean follow-up was 25.2±8.6 [7-40] months. Preoperative mean PROMs showed statistically significant overall improvement (P<0.001) postoperatively to final follow-up. Four patients without wide footprint cages at L4/5 or L5/S1, suffered DJF and reported regret undergoing surgery. Statistically significant difference (P<0.001) between preoperative and surgical plan in SVA and PI-LL but not in PT (P=0.058). No statistically significant difference in surgical plan versus the postoperative SVA, PI-LL, and PT (due to difficulty achieving the surgical plan, and also to maintaining the correction). One patient suffered PJF. There was a mean proximal kyphotic angle (PKA) of 17.8±13.0 degrees and PJK risk score of 3.7±1.0 with 40% who experienced PJK. No rod breakages were observed. In this series, PSSR improved PROMs and treated ASD. Sagittal parameters planned preoperatively correlated with postoperative correction. PJF was reduced, compared to the literature (35%), but PJK was observed over time. DJF occurred and was related to the absence of interbody cages at the lumbosacral junction and decisional regret.

Postoperative Changes of Spinopelvic Sagittal Parameters After Cervical Laminoplasty for Cervical Spondylotic Myelopathy.

A retrospective analysis of prospectively collected data. To investigate postoperative changes of spinopelvic sagittal parameters after laminoplasty for cervical spondylotic myelopathy (CSM) accompanying postoperative cervical kyphotic deformity or cervical regional sagittal imbalance. To the best of our knowledge, no study has been reported concerning postoperative changes of spinopelvic sagittal parameters accompanying postoperative deterioration of cervical sagittal alignment or balance after cervical laminoplasty. Forty-five CSM patients without preoperative cervical kyphosis who underwent laminoplasty were included. None of the 45 patients had a medical history of previous spine surgery, hip joint surgery, or knee joint surgery. The patients were divided into 2 groups (kyphosis and lordosis groups) according to postoperative C2-7 angle, and they were also divided into 2 other groups (imbalance and balance groups) according to postoperative C1-7 sagittal vertical axis. Postoperative changes (Δ) of T1 slope (T1S), thoracic kyphosis, thoracolumbar kyphosis (TLK), lumbar lordosis (LL), Pelvic tilt, and C7 sagittal vertical axis were measured comparing lateral radiographs of the whole spine in the standing position taken at 1 year postoperatively with those before surgery. Both T1S and TLK significantly decreased after cervical laminoplasty in the kyphosis group compared with the lordosis group. On the other hand, both T1S and TLK increased significantly, and LL significantly decreased after surgery in the imbalance group compared with the balance group. At 1 year after laminoplasty for CSM, both T1S and TLK significantly decreased accompanying postoperative cervical kyphotic deformity as a compensatory action for postoperative cervical kyphosis to maintain the global sagittal balance of the spine, whereas both T1S and TLK increased significantly, and LL significantly decreased accompanying postoperative cervical reginal sagittal imbalance which resulted in postoperative forward inclination of the whole spine.

Influence of Spinopelvic Alignment on the Clinical Outcomes Following Decompression Surgery for Lumbar Stenosis.

Introduction The role of sagittal spinopelvic alignment in lumbar spinal stenosis (LSS) patients and its potential influence on post-decompression surgery outcomes is a topic of growing interest. Lumbar spinal stenosis is a prevalent degenerative condition, and with an aging population, the frequency of surgical interventions for LSS has risen. While decompression surgery aims to relieve symptoms, the potential impact of preoperative spinopelvic alignment on postoperative results remains controversial. This study examined the correlation between sagittal spinopelvic parameters and clinical outcomes in LSS patients undergoing decompression surgery. Methods This study included 100 patients with LSS who underwent decompression surgery between 2021 and 2023 and 100 healthy individuals as a control group. The LSS group comprised 50 men and 50 women, with a mean age of 55.8±12.41 years, while the control group consisted of 50 men and 50 women, with a mean age of 55.17±13.39 years. Sagittal spinopelvic alignment parameters, including pelvic tilt (PT), pelvic incidence-lumbar lordosis mismatch, and sagittal vertical axis, were assessed preoperatively. Postoperative clinical outcomes were evaluated using the visual analog scale (VAS) and Oswestry disability index (ODI) scores. Results In the cohort of 200 participants, 100 were diagnosed with lumbar spinal stenosis (LSS), and 100 were healthy controls. Both groups had an equal gender distribution (50 males and 50 females). The mean age was 55.8 (±12.4) years for the LSS group and 55.2 (±13.4) years for the control group. Among the analyzed radiographic parameters, only lumbar lordosis (LL) levels showed a significant difference between groups, notably lower in the LSS group (p=0.020). Preoperative VAS scores in LSS patients averaged 7.58±1.32, which postoperatively dropped to 2.22±1.95 (p<0.001). Similarly, ODI (%) declined from a preoperative average of 55.76±11.65 to 18.62±18.17 postoperatively (p<0.001). Patients with postoperative ODI levels exceeding 20% had higher preoperative scores and significantly altered radiographic measurements. The receiver operating characteristic (ROC) analysis indicated PT as the most predictive radiographic parameter, with an area under the curve (AUC) of 0.945. Multivariate logistic regression pinpointed PT and LL as key predictors associated with increased risks for postoperative Oswestry disability levels exceeding 20%. Conclusion Our study suggests that sagittal spinopelvic alignment plays an important role in the development and progression of LSS. Addressing sagittal alignment may be crucial for achieving optimal clinical outcomes afterdecompression surgery. Further research is needed to elucidate the mechanisms underlying the relationship between sagittal alignment and LSS.

Spinopelvic sagittal realignment and incidence of adjacent segment disease after single-segment posterior lumbar inter-body fusion using 12° lordotic cages-a 2-year prospective cohort study.

The importance of spinopelvic sagittal alignment for adjacent segment disease (ASD) after lumbar fusion surgery has been reported. However, no longitudinal cohort studies have determined the extent to which segmental alignment and spinopelvic global alignment can be achieved using 12° lordotic cages in posterior lumbar inter-body fusion (PLIF) and the extent to which the development of ASD can be prevented. The purpose of this study was to analyze changes in segmental and spinopelvic sagittal alignment after single-segment PLIF with 12° lordotic cages, to clarify the relationship between changes in segmental and spinopelvic sagittal alignment, and to report the incidence of ASD at 2 years postoperatively. Subjects in this 2-year prospective longitudinal cohort study were 28 patients who had undergone L4/5 PLIF using 12° lordotic cages. Incidence of operative ASD (O-ASD) was evaluated as clinical outcomes. Radiological measurements were examined preoperatively and at 3 months, 1 year and 2 years postoperatively. The following radiographic spinopelvic parameters were measured: segmental lordosis (SL) at L4/5; sagittal vertical axis (SVA); T1 pelvic angle (TPA); thoracic kyphosis (TK); lumbar lordosis (LL); sacral slope (SS); pelvic tilt (PT); and pelvic incidence (PI). With respect to radiological outcomes, changes in SL (ΔSL) and spinopelvic parameters and the incidence of radiological ASD (R-ASD) were evaluated. Correlations of ΔSL and changes in other spinopelvic parameters (ΔSVA, ΔTPA, ΔTK, ΔLL, ΔSS, ΔPT, and ΔPI-LL) between preoperatively and 3 months postoperatively were examined. The follow-up rate was 100% (n=28) at 1 year postoperatively and 96.4% (n=27) at 2 years postoperatively. No cases of O-ASD were seen during 2 years of follow-up. Significant realignment was observed and maintained at 2 years postoperatively in almost all spinopelvic sagittal parameters (SL, SVA, TPA, LL, PT, PI-LL). Regarding the correlation between ΔSL and other parameters, significant correlations were detected with ΔSVA (r=-0.37, P<0.05) and ΔLL (r=0.538, P<0.01). Three cases (11.1%) showed R-ASD at 2 years postoperatively. PLIF with 12° lordotic cages for L4 degenerative spondylolisthesis improved SL and global sagittal realignment, and achieved satisfactory clinical outcomes with a low incidence of ASD during 2 years of follow-up.

Walking status and spinopelvic parameters in young children with achondroplasia: 10-year follow-up.

Thoracolumbar kyphosis (TLK) is common in children with achondroplasia and resolves in 90% by 10years of age. Our purpose was to describe the natural progression of TLK in a cohort of pre-walking children with achondroplasia. A single-center, retrospective review identified 62 children (32 male, 30 female) with achondroplasia. Clinical information and sagittal spinopelvic parameters were collected. The children were divided into positive pelvic tilt (PT) and negative PT. All parents were routinely counseled about unsupported sitting. Spontaneous resolution rate was 64.5% at 1-year post-walking, 74.2% at 5years of age, and 88.7% at 10years of age. None of the children required posterior spinal decompression and fusion for progressive deformity or symptomatic spinal stenosis. At 1-year post-walking, the negative PT group had a higher sacral slope (p = 0.006), higher lumbar lordosis (p < 0.001), and lower pelvic incidence (p < 0.001). This relationship remained constant up to 10years of age, and there was no association with TLK. In this largest series to date, spontaneous resolution of TLK in children with achondroplasia was 64.5% at 1-year post-walking, 74.2% at 5years of age, and 88.7% in children followed to 10years of age. With early identification and regular follow-up with patient education, no patient in this series required treatment or developed symptomatic spinal stenosis. While not predictive of resolution of TLK, the dichotomous presentation of PT in young children with achondroplasia persists at 5 and 10years of age and reliably predicts the spinopelvic parameters. III-retrospective comparative study.

Comparative Study for Characteristics of Locomotive Syndrome in Patients with Lumbar Stenosis and Adult Spinal Deformity.

The differential diagnoses of lumbar spinal stenosis (LSS) and adult spinal deformity (ASD) have been demonstrated primarily using sagittal radiographic spinopelvic parameters. However, it is more important to know the differences in the characteristic clinical symptoms to make accurate treatment decisions. Recently, the relationship between spinal disease and Locomotive Syndrome (LS) has been reported. Additionally, the Geriatric Locomotive Function Scale-25 (GLFS-25) was reported to be a useful scale to evaluate disease severity and characteristic clinical symptoms in spinal disease. Sixty-nine consecutive patients with ASD and 196 patients with LSS who underwent spinal surgery were included. Locomotive dysfunction was evaluated using the GLFS-25 questionnaire and physical performance tests including the two-step test and the stand-up test, measured preoperatively. The correlations between sagittal spinopelvic parameters of ASD and LS were examined. All subjects with lumbar degenerative disease in the present study were diagnosed with LS preoperatively. The severity of LS in patients with LSS and ASD were statistically similar. GLFS-25 scores in the mobility and community domain were similarly poor in both groups. Several scores in the domestic life and self-care domains were significantly worse in the ASD group. Question 20 of the GLFS-25, related to load-bearing tasks and housework, was significantly associated with a large pelvic incidence in ASD patients. Lumbar degenerative disease requiring surgery severely affects the LS of older people. ASD patients had more difficulty with load-bearing tasks and housework such as cleaning the yard, carrying heavy bedding, dressing, and bathing compared to LSS patients.

Correcting intervertebral rotation and scoliosis simultaneously by oblique lumbar interbody fusion: a 3D analysis of EOS images.

With advancements in minimally invasive techniques, oblique lumbar interbody fusion (OLIF) has gained widespread acceptance and is now commonly performed for adult degenerative scoliosis (ADS). The objective of this research paper is to evaluate three-dimensional (3D) intervertebral motions in EOS models before and after surgery and subsequently assess the efficacy of the 3D correction achieved through staged OLIF. In this retrospective study, 29 consecutive patients diagnosed with ADS were included, with a mean age of 63.6 years, who underwent staged OLIF surgery between 2018 and 2021. Spinopelvic parameters were assessed using EOS images, and 3D models were reconstructed to measure intervertebral motion angles (IMAs) in 70 surgical intervertebral segments, comprising wedge, lordosis, and axial rotation angles. Regression analysis was conducted to compare IMAs in different planes before and after the staged OLIF surgery. Significant three-dimensional correction was observed in 70 intervertebral segments following the first-stage OLIF. The wedge angles decreased from 5.2°± 4.2° to 2.7°± 2.4° (P < 0.001). The lordosis angles increased from 5.1°± 5.9° to 7.8°± 4.6° (P = 0.014), while the axial rotation angles decreased from 3.8°± 2.6° to 2.3°± 2.1° (P < 0.001). Linear regression analysis revealed a positive correlation between wedge angles and axial angles preoperatively (P < 0.001, r = 0.43), as well as between corrected wedge angles and corrected axial angles (P < 0.001, r = 0.42). This study demonstrated that intervertebral motions had a correlation between coronal and axial planes in lumbar degenerative scoliosis. First-stage OLIF was efficient at correcting segmental scoliosis by inserting cages while correcting rotation deformity simultaneously, as well as improving the sagittal spinopelvic parameters.

The Impact of Spinopelvic Alignment on the Facet Joint Degeneration.

Retrospective Cohort. This study aims to evaluate the relations between facet joint degeneration (FD) and sagittal spinopelvic parameters. Second, the association of FD with degenerative disc disease (DDD) and lumbar disc herniations (LDH) was assessed. The radiologic data of 192 patients was retrospectively analyzed. Total, proximal, and distal lumbar lordosis (LL, PLL, and DLL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sacral table angle (STA) were measured on lumbar x-ray plates. DDD and FD was graded on the MRI images. The apex of lumbar lordosis and PI-LL imbalance were noted in each patient. Correlation analyses were performed. Age and body mass index (BMI) were correlated with FD. LL and DLL are positively associated with upper-level FDs (L1-2 and L2-3) (P < 0,05). PLL were positively associated with lower level FD (L5-S1) (P < 0,05). A significant increase in PI was associated with FD in L2-3 and L4-5. A larger PT was found in FD in L4. The PI-LL imbalance was not correlated with the FD. Correlation between DDD and LDH and FD was observed in each level (P < 0,01). The level of FD is not affected by the apex of the curve. Age and BMI have a direct impact on FD. However, spinopelvic parameters influence the severity of FD rather than its occurrence. In addition to the effects of lumbar lordosis as a single entity, it is essential to consider separately the effects of proximal and distal lumbar lordosis at the FD level.

The relationship between spino-pelvic alignment and primary dysmenorrhea.

Most women of reproductive age suffered from the primary dysmenorrhea (PD). Up to date, most studies on the etiology of dysmenorrhea focused on endocrine factors while ignored the effect of spino-pelvic bony anatomy on uterus. In this study, we innovatively shed light on the relationship between primary dysmenorrhea and sagittal spino-pelvic alignment. 120 patients diagnosed with primary dysmenorrhea and a control group of 118 healthy volunteers were enrolled into this study. All subjects received the standing full-length posteroanterior plain radiography to evaluate the sagittal spino-pelvic parameters. The visual analog scale (VAS) was used to assess pain rating of primary dysmenorrhea patients. Analysis of variance (ANOVA) or Student's t test was performed to measure statistical significance between differences. There was a significant difference in pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL) and thoracic kyphosis (TK) between PD group and Normal group (P<0.05). Furthermore, in PD group, the PI and SS was significant different between mild pain group and moderate pain group (P<0.05) and there was a significant negative correlation between pain rating and SS. From the perspective of sagittal spinal alignment, the majority of PD patients were classified with Roussouly type 2, meanwhile most normal people were classified with Roussouly type 3. Sagittal spino-pelvic alignment was related to primary dysmenorrhea symptoms. Lower SS and PI angles may contribute to a worsen pain in PD patients.

Single Posterior Surgery Versus Combined Posterior–Anterior Surgery for Lumbar Tuberculosis Patients

Posterior approach of debridement, interbody graft, and instrumentation, and combined posterior-anterior approach of posterior instrumentation and anterior debridement and interbody graft are two essential surgeries for the surgical treatment of spinal tuberculosis (TB), and, until now, which one should be chosen is still controversial. This study aimed to compare the therapeutic efficacy between the single posterior surgery and combined posterior-anterior surgery for lumbar tuberculosis (LTB) patients to elucidate the role of debridement and the effects that result from posterior structure resection. One hundred and nineteen LTB patients managed with single posterior debridement, interbody graft, and instrumentation surgery (Group P, 73 cases), or combined posterior-anterior surgery of posterior instrumentation and anterior debridement and interbody graft (Group P-A, 46 cases) from January 2008 to December 2016 were retrospectively analyzed. Different indexes were compared between the two groups to evaluate the curative effect and explore the role of debridement and the effects that result from posterior structure resection: operation time, blood loss, visual analog scale (VAS), Japanese Orthopaedic Association (JOA), Erythrocyte Sedimentation Rate (ESR), C-reactive Protein (CRP), surgical complication type and rate, spinopelvic sagittal parameters (local kyphosis [LK], pelvic incidence [PI] and pelvic tilt [PT], lumbar lordosis [LL], and sacral slope [SS]), drainage retention duration, hospital stay, time of abscess disappearance, time of activity recovery, and time of bone graft fusion by t-test or χ2 test. The follow-up period ranged from 24 to 60months. No significant variations were detected between the two groups for age, sex ratio, BMI, disease duration, indication, and the preoperative values of VAS, JOA, ESR, CRP, and LK (p > 0.05). The VAS, JOA, ESR, and CRP significantly improved in both groups after the operation (p < 0.05), along with the LK and LL (p < 0.05). Meanwhile, the SS, PI, and PT showed minor improvement after the operation (p > 0.05). Compared to the P-A group, the P group had shorter operation time and less blood loss and hospital stay (p < 0.05). However, both groups presented similar VAS, JOA, ESR, CRP, and LK improvements (p > 0.05). Additionally, the surgical complication type and rate, postoperative spinopelvic sagittal parameters, and bone graft fusion time did not differ between the two groups (p > 0.05). On the other hand, the patients in the P-A group had a shorter time of abscess disappearance and activity recovery (p < 0.05) but a similar time of drainage retention (p > 0.05) compared to the P group. Both single posterior and combined posterior-anterior surgeries presented a good therapeutic effect for LTB patients with a low surgical complication rate and good quality of LK correction and LL reconstruction and maintenance. Moreover, single posterior surgery was less traumatic than combined posterior-anterior surgery but with slower TB lesion healing and activity recovery. Compared to debridement, stability seems to be more vital for STB healing, posterior structure resection does not affect the effect of spinopelvic realignment.

Effect of Brace Treatment on Craniovertebral to Lumbopelvic Sagittal Parameters in Adolescents with Idiopathic Scoliosis: A Systematic Review.

The current study was carried out systematically by conducting a review of the literature. The purpose of this study was to conduct a systematic review of the literature to determine the effects of brace wearing on sagittal parameters in adolescents with idiopathic scoliosis (AIS). In this study, PubMed/MEDLINE (National Library of Medicine), Scopus, Ovid, CINAHL, PEDro, Google Scholar, and the Cochrane Library were accessed and searched using the patient, intervention, comparison, outcome, and study design model. We included studies that looked at the effects of brace treatment on sagittal spinopelvic parameters in AIS patients over the age of 18. The studies were chosen for their cross-sectional, retrospective, or prospective observational designs, and they were published in English. Review articles, case reports, case study designs, and conference abstracts were excluded from consideration. The methodological quality of the remaining articles was assessed using the Newcastle Ottawa Scale. A total of 12 studies were chosen, and 995 participants were evaluated, with 3 (25%) and 9 (75%) having high and moderate quality, respectively. The studies were classified based on the length of follow-up. Long-term, short-term, and immediate effects of brace wearing on sagittal spinopelvic parameters were reported in four, five, and three studies, respectively. The results of nine studies showed a significant decrease in Cobb angle after wearing the brace, which contradicted the findings of the other two. The cervical and sagittal pelvic parameters, thoracic kyphosis (TK), lumbar lordosis (LL), spinopelvic parameters, and sagittal balance were all evaluated in the intended studies, yielding varying results. According to the available literature, wearing a brace flattens the TK and LL. According to this systematic review, brace treatment may affect sagittal spinopelvic parameters in adolescents with AIS, particularly in TK and LL. The cervical and pelvic parameters yielded inconclusive results. This study backs up the idea that brace design and structure can influence sagittal parameter changes. The limitations of this study include different methods of parameter measurement, variations in the brace types and wear time, varying follow-up duration, and differences in participant characteristics.