Sagittal alignment correction and reconstruction of lumbar post-traumatic kyphosis via MIS lateral approach.
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ABSTRACT:
SUBMITTER: Berjano P
PROVIDER: S-EPMC3508238 | biostudies-literature | 2012 Dec
REPOSITORIES: biostudies-literature
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Sagittal alignment correction and reconstruction of lumbar post-traumatic kyphosis via MIS lateral approach.
Berjano Pedro P Damilano Marco M Lamartina Claudio C
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 20121201 12
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Project description: Not available
| S-EPMC3508243 | biostudies-literature
Project description:BackgroundThe benefit of surgical intervention over conservative treatment for degenerative lumbar spondylolisthesis (DLS) patients with neurologic symptoms is well-established. However, it is currently unclear what breadth of available evidence exists on regional and global sagittal alignment in DLS surgery. As such, the purpose of the current study is to conduct a scoping review to map and synthesize the DLS literature regarding the current radiographic assessment of sagittal spinal alignment in DLS surgery.MethodsA comprehensive search of the MEDLINE, EMBASE and Cochrane databases from January 1971 to January 2023 was performed for all DLS studies examining sagittal spinal alignment parameters with DLS surgery according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review (PRISMA-ScR) protocol.ResultsFrom 2,222 studies, a total of 109 studies were included, representing 10,730 patients with an average age of 63.0 years old and average follow-up of 35.1 months postoperatively. Among included studies, 93 (85%), were largely published in the last decade and predominantly represented retrospective cohorts 70 (64%) or case series 22 (20%). A common theme among the reporting of radiographic parameters in the included investigations was the assessment of the magnitude and/or maintenance of a radiographic change postoperatively, with 92 (84%) studies reporting these findings. The majority of studies focused on index DLS level [33 (30%) studies] or lumbar spine radiographic imaging [33 (30%) studies] only. Thirty-seven (34%) studies reported spinopelvic parameters, with only 13 (12%) of included studies assessing 36-inch standing lateral radiographs and overall alignment.ConclusionsThere is increasing prevalence of investigations assessing sagittal spinal alignment parameters in DLS surgery. Although, there is an increasing prevalence of studies investigating sagittal spinal alignment parameters in DLS surgery the quality of the currently available literature on this topic is of overall low evidence and largely retrospective in nature. Additionally, there is limited analysis of global sagittal spinal alignment in DLS suggesting that future investigational emphasis should prioritize longitudinally followed large prospective cohorts or multi-centre randomized controlled trials. Attempts at standardizing the radiographic and functional outcome reporting techniques across multi-centre investigations and prospective cohorts will allow for more robust, reproducible analyses of significance to be conducted on DLS patients.
| S-EPMC10570642 | biostudies-literature
Project description:BACKGROUND:Pain and disability associated with degenerative lumbar spondylolisthesis (DLS) results in significant burden on both the patients' quality of life and healthcare costs. Currently, there is controversy regarding the specificity of spinopelvic measures of sagittal plane alignment with respect to DLS. Moreover, the correlation among spinopelvic parameters of sagittal plane alignment remains to be clarified. Our aim in this study was to compare these measurements between patients with single-segment DLS at L5 and a control group with no history of DLS. METHODS:Our study group was formed of 132 patients who underwent full length lateral view radiographs of the spine in a relaxed standing posture. Among these, DLS at L5 was identified in 72 patients, forming the DLS group, with no radiographic evidence of lumbar spine disease in the remaining 60 patients, forming the control group. The patient and control groups were balanced with regard to age and sex distribution. The following spinopelvic parameters of sagittal plane alignment were measured: angle of incidence (PI) and tilt (PT) of the pelvis; sacral slope (SS); thoracic kyphosis (TK); lumbar lordosis (LL); and the spinal sagittal vertical axis (SVA). The Meyerding grade of L5 slippage was quantified for each patient in the DLS group. RESULTS:Measures of TK, PI, SS, and LL were significantly greater in the DLS than control group (P < 0.05), with no between-group difference in SVA and PT. In the DLS group, the grade of L5 slippage correlated with SS (r = 0.873, P < 0.0001), PI (r = 0.791, P < 0.0001) and LL (r = 0.790, P < 0.0001). Moreover, the measurement for SS correlated more strongly with the PI (r = 0.94, P < 0.01) than the LL (r = 0.69, P < 0.01). CONCLUSION:Measurements of SS, PI, and LL were specifically associated with DLS, with measurements correlating positively with the grade of slippage.
| S-EPMC5956921 | biostudies-literature
Project description:ObjectiveIn this study, we evaluated factors affecting changes in cervical lordosis after deformity correction and during follow-up period in adult spinal deformity (ASD) patients with severe sagittal imbalance.MethodsSeventy-nine patients, with an average age of 71.6 years, who underwent long-segment fixation from T10 to S1 with sacropelvic fixation were included. We performed a comparative analysis of the radiographic parameters after surgery (Post) and at the last follow-up (Last). We calculated the Pearson's correlation coefficient and performed multilinear regression analysis to predict independent parameters for Post and Last cervical lordosis (CL), T1 slope (T1S), and thoracic kyphosis (TK).ResultsHyperlordotic changes of -23.3° in CL before surgery was reduced to -7° after surgery, and Last CL had increased to -15.3°. T1S was reduced from 27° before surgery to 14.4° after surgery and had increased to 18.8° at the last follow-up. Through multilinear regression analysis, we found that Post CL and T1S were more significantly affected by the amount of LL correction (p = .045 and .049). The effect of Last T1S was significantly associated with the Last CL; the effect of Last TK, with the Last T1S; and the effect of Post PI-LL, with the Last TK (p < .05).ConclusionThe postoperative kyphotic change in CL in ASD patients with preoperative cervical hyperlordosis is not permanent and is affected by drastic LL correction and SVA restoration. To achieve spinopelvic harmony proportional to the difference in LL relative to PI, TK becomes modified over time to increase T1S and CL, in an effort to achieve optimal spine curvature.
| S-EPMC8289077 | biostudies-literature
Project description:Still little is known about how spinopelvic alignment affects spinal load distribution. Musculoskeletal modeling can potentially help to discover associations between spine alignment and risk factors of spinal disorders (e.g. disc herniation, vertebral fracture, spondylolisthesis, low back pain). The present study exploited the AnyBody full-body musculoskeletal model to assess the relation between lumbar loads and spinopelvic alignment in the sagittal plane. The model was evaluated in the standing position. The simulated postures were set using spinopelvic parameters gleaned from the literature and characterizing the healthy adult population. The parameters were: sagittal vertical axis, Roussouly lumbar type, sacral slope, and pelvic incidence. A total of 2772 configurations were simulated based on the following measurements: compression force and anterior shear at levels L4L5 and L5S1; multifidus, longissimus spinae, and rectus abdominis muscle forces. Changes in global sagittal alignment, lumbar typology, and sacral inclination, but not in pelvic incidence, were found to affect intervertebral loads in the lumbar spine and spinal muscle activation. Considering these changes would be advantageous for clinical evaluation, due to the recognized relation between altered loads and risk of disc herniation, vertebral fracture, spondylolisthesis, and low back pain. Musculoskeletal modeling proved to be a valuable biomechanical tool to non-invasively investigate the relation between internal loads and anatomical parameters.
| S-EPMC6422292 | biostudies-literature
Project description:BackgroundFailure to restore lordotic alignment is not an uncommon problem following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF), even with expandable cages that increase disc height. This study aims to investigate the effect of the expandable cage that is specifically designed to expand both height and lordosis. We evaluated the outcomes of MIS TLIF in restoring immediate postoperative sagittal alignment by comparing two different types of expandable cages. One cage is designed to solely increase disc height (Group H), while the other can expand both height and lordosis (Group HL).MethodsPatients undergoing MIS TLIF using expandable cages were retrospectively reviewed, including 40 cases in Group H and 109 cases in Group HL. Visual analog scores of back and leg pain, and Oswestry disability index were collected. Disc height, disc angle, and sagittal alignment were measured. Complications were recorded, including early subsidence which was evaluated with computed tomography.ResultsClinical and radiographic outcomes significantly improved in both groups postoperatively. Group HL showed superior improvement in segmental lordosis (4.4°±3.5° vs. 2.1°±4.8°, P=0.01) and disc angle (6.3°±3.8 vs. 2.2°±4.3°, P<0.001) compared to Group H. Overall incidence of early subsidence was 23.3%, predominantly observed during initial cases as part of the learning curve, but decreased to 18% after completion of the first 20 cases.ConclusionsExpandable cages with a design specifically aimed at increasing lordotic angle can provide favorable outcomes and effectively improve immediate sagittal alignment following MIS TLIF, compared to conventional cages that only increase in height. However, regardless of the type of expandable cage used, it is crucial to avoid applying excessive force to achieve greater disc height or lordosis, as this may contribute to subsidence and a possible reduction in lordotic alignment restoration. Long-term results are needed to evaluate the clinical outcome, fusion rate, and maintenance of the sagittal alignment.
| S-EPMC10982918 | biostudies-literature
Project description:PurposeThe aim was to assess the clinical outcomes after posterior spinal fusion (PSF) in patients with Scheuermann's disease (SD).MethodsSD undergoing PSF were retrospectively analyzed. Clinical outcome was determined using SRS-22- and Eq. 5D-questionaires preop and after 3, 12, 24 months after surgery. Whole spine x-rays were analyzed (preop, postop, after 6, 12, 24 months): sagittal and coronary Cobb angles, and pelvic parameters were evaluated; ideal lumbar lordosis (LL) was calculated using formula of le Huec (LL = 0.54*PI + 27.6). Surgical time, complications and blood loss were compared. Postop appearance of proximal (PJF) and distal junction failure (DJF) were calculated. Values were given as mean. Comparison with significance α = 0.05.Results73 patients were included. SRS-22 total score and EQ5D showed significant increase from preop to two-year FU (each p < 0.001). Preop Thoracic kyphosis (TK) was 75.1° with significant correction to 48.5° (p < 0.001). LL showed mean correction from 68.2° to 46.7° (p < 0.001). Difference between ideal and measured LL showed improvement from - 17.2° preop to -3.3° 6 month postop, good spontaneous correction of hyperlordosis. 63% had < 10° deviation from ideal LL 6 month postoperatively, whereas only 21.4% were in this range preoperatively. No significant changes for spinopelvic parameters during FU. Complications occurred in 13,7% of cases. A low revision rate for PJF (2,7%) was necessary. Subscore mental health showed a correlation to preop TK (p < 0.05).ConclusionPhysiological reconstruction of sagittal alignment could be achieved in most cases (63%). Clinical FU results were convincing with significant improvement of patient's satisfaction. Complication rate was moderate and risk of PJF after PSF low.
| S-EPMC11773709 | biostudies-literature
Project description:Sagittal rebalancing of a fixated lumbar hypolordosis (kyphosis) is very important to gain satisfactory results. To correct a misalignment vertebral column resection or pedicle subtraction osteotomies are favored, disregarding the relatively high complication rates. The aim of this study was to evaluate the efficiency and safety of a new modified transforaminal lumbar fusion technique as an alternative.We conducted a retrospective review (06/2011-06/2015 ) of a prospective database at an University hospital. Inclusion criteria were adult patients with a fixated lumbar hypolordosis and the need of monosegmental correction of more than 10° with an mTLIF. Exclusion criteria consisted of minor aged patients and polysegmental corrections. Study parameters were the perioperative complications and the achieved postsurgical lordosis. The follow up period was 6 months.A total of 11 patients could be included. The mean segmental lordosis was -2.3° ± 12.4° (range -22° to 14°) preoperative and 15.5° ± 10.5° (range 0° to 29°) postoperative. The degree of correction was 17° ± 5.7° in mean per treated segment (range 12° to 29°). No neurologic or vascular complications occurred. No substantial loss of correction or implant failure was noted during the 6-month follow-up.The modified transforaminal lumbar fusion technique is a safe method to correct a fixated lumbar kyphosis. The potential of segmental correction is comparable to pedicle subtraction osteotomies but sparing potentially healthy segments.
| S-EPMC5497383 | biostudies-other
Project description:BackgroundLittle is known about the progression of Thoracolumbar kyphosis (TLK) in achondroplasia. The aim of the study was to evaluate natural progression of TLK and establish risk factors for progression.MethodsWe reviewed 21 patients (11 males, 10 females) diagnosed clinically and radiographically with achondroplasia as infants and followed for a minimum of 5 years from infancy, and analyzed to compare differences between data at 0, 1, 3, 5, 7-10, and 11-18 years old. Subjects (n=21) were divided into two groups with and without TLK >20° at the thoracolumbar junction on lateral standing radiographs at age 3.ResultsTLK >20° occurs in 76.2% of infants in the first 7 months of life. Sagittal parameters at 0, 1, 3, 5, 7-10, and 11-18 years old differed significantly for cervical lordosis (CL), thoracic kyphosis (TK), TLK, lumbar lordosis (LL), pelvic tilt (PT), and sacral slope (SS). TK, LL, and SS increased significantly with increasing age, whereas CL, TLK, and PT were significantly lower in older age groups (P < 0.05). In 6 of 7 patients with TLK >20° at age 3, TLK had progressed or was still >20° at age 5. The prevalence of TLK >20° at age 3 was 33.3% (7/21). There was a significant difference in age at independent walking among subjects with and without TLK at age 3 (31.4±17.1 vs. 16.1±3.4 months, P < 0.01). Radiologic parameters associated with TLK showed significant differences between subjects with and without TLK at age 3, including TLK, TK, TLK, LL, and SVA at age 5; and TLK at ages 7-10 and 11-18.ConclusionsThese results suggest that sagittal alignment at 3 years old determines future TLK in achondroplasia. Progression of deformity and neurological impairments require consideration in treatment planning.
| S-EPMC8819874 | biostudies-literature
Project description:Study Design The study is a case report. Objective The authors aim to report an unusual injury pattern in a patient previously treated for thoracic kyphoscoliosis. Methods A postoperative (computed tomography) CT of a healthy 24-year-old man who underwent posterior instrumentation and fusion for a kyphoscoliosis deformity was compared with a CT performed after a motor vehicle accident (MVA) 1 year later, which resulted in an extension-distraction injury of T8 with no neurologic deficit. Cobb angles of the thoracic sagittal images of both CTs were measured using a digital measuring device and the values were recorded. Results Initial postoperative sagittal CT images demonstrate a 67-degree residual thoracic kyphosis compared with the post-MVA sagittal CT images, which reveal a 54-degree thoracic kyphosis, a 13-degree improvement in sagittal alignment. Conclusion It is unusual for a patient with long posterior instrumentation of the spine to sustain a spinal fracture without breakage of the rods, which were 6-mm nickel-titanium alloy with two crosslinks. Although sustaining plastic deformation, the rods maintained their integrity to the degree that the patient required no subsequent treatment to his spine at 12 months follow-up. It is rare to sustain a vertebral fracture without implant failure, which occurred in this case.
| S-EPMC3836883 | biostudies-other