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01-06-2015 | Original Article

Cervical spine alignment following lumbar pedicle subtraction osteotomy for sagittal imbalance

Authors: Ibrahim Obeid, Anthony Boniello, Louis Boissiere, Anouar Bourghli, Vincent Pointillart, Olivier Gille, Virginie Lafage, Jean-Marc Vital

Published in: European Spine Journal | Issue 6/2015

Abstract

Purpose

The alignment of the cervical spine is of primary importance to maintain horizontal gaze and contributes to the functional outcome of patients. Cervical spine alignment after correction of major sagittal imbalance has rarely been reported in the literature.

Methods

Retrospective review of 31 consecutive patients with sagittal plane deformities operated by lumbar pedicle subtraction osteotomy. Pre-operative and 3 months post-operative full-length radiographies were analyzed for spinopelvic and cervical-specific parameters.

Results

There was a significant increase in lumbar lordosis (LL), thoracic kyphosis, and sacral slope. There was also a significant decrease in pelvic tilt, pelvic incidence minus LL, knee flexion and sagittal vertical axis. The cervical analysis revealed that there was no significant difference between pre- and post-operative global cervical lordosis (CL) angle and external auditory meatus (EAM) tilt. There was a significant decrease of C7 slope and distal CL, while a significant increase in occipito-C2 (OC2) angle was observed.

Conclusion

LL restoration decreased the need of compensation at the pelvis and thoracic spine. The distal CL and C7 slope decreased because there was no need for compensation at this level after the surgery, but the proximal cervical spine takes a slightly flexed position to maintain horizontal sight. EAM tilt measures the head position toward C7, and is close to 0° even in severe cases. Changes of this parameter after surgery are insignificant, probably due to the balance between upper and lower cervical segments; when one of these segments shifts backward the other shifts forward and the result is a balanced head over C7.

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Title: Cervical spine alignment following lumbar pedicle subtraction osteotomy for sagittal imbalance
Authors: Ibrahim Obeid
Anthony Boniello
Louis Boissiere
Anouar Bourghli
Vincent Pointillart
Olivier Gille
Virginie Lafage
Jean-Marc Vital
Publication date: 01-06-2015
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 6/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3738-4

At a glance: The STEP trials

Springer Medicine

Cervical spine alignment following lumbar pedicle subtraction osteotomy for sagittal imbalance

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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