Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Spine Journal
Published in: European Spine Journal 8/2016

01-08-2016 | Original Article

Overcorrection of lumbar lordosis for adult spinal deformity with sagittal imbalance: comparison of radiographic outcomes between overcorrection and undercorrection

Authors: Jung-Hee Lee, Ki-Tack Kim, Sang-Hun Lee, Kyung-Chung Kang, Hyun-Seok Oh, Young-Jun Kim, Hyuk Jung

Published in: European Spine Journal | Issue 8/2016

Login to get access

Abstract

Purpose

To determine the correlation of the difference between postoperative lumbar lordosis (LL) and ideal LL with the sagittal vertical axis (SVA) at the final follow-up in patients with adult spinal deformity (ASD).

Methods

Fifty-one patients with degenerative lumbar kyphosis (DLK) (mean age 66.5 years) who underwent surgical correction with a minimum 2-year follow-up were evaluated. Based on the difference between postoperative LL and ideal LL using the Korean version of Legaye’s formula, we divided the 51 patients into two groups: overcorrection (degree of postoperative LL > ideal LL) and undercorrection (degree of postoperative LL < ideal LL).

Results

Our clinical series of patients comprised 24 in the overcorrection and 27 in the undercorrection group. No significant differences were found in preoperative pelvic incidence (PI 52.6° vs. 57.3°), sacral slope (SS 23.3° vs. 18.3°), LL (−6.9° vs. −2.3°), thoracic kyphosis (TK 4.7° vs. 4.9°) and SVA (140 vs. 139 mm) except pelvic tilt (PT 29.4° vs. 39.0°), between the two groups. All the patients in the overcorrection group and 16 in the undercorrection group achieved postoperative optimal sagittal balance based on SVA ≤ 50 mm. In addition, significant differences in PT (10.5° vs. 26.7°), SS (42.1° vs. 30.6°), LL (−64.3° vs. −37.1°), TK (22.6° vs. 15.8°), and SVA (−1 vs. 41 mm) between the two groups were observed postoperatively. Furthermore, four patients (16.7 %) in the overcorrection group and eight (50 %) in the undercorrection group had sagittal decompensation at the final follow-up. Our results showed that the difference between postoperative LL and ideal LL had a significant correlation with postoperative and final follow-up SVA in our clinical series.

Conclusion

Overcorrection of LL is an effective treatment modality to maintain optimal sagittal alignment in patients with DLK; this suggests that it should be considered in preoperative planning for patients with ASD with sagittal imbalance.
Literature
1.
Farcy JP, Schwab FJ (1997) Management of flatback and related kyphotic decompensation syndromes. Spine 22:2452–2457CrossRefPubMed
2.
Jackson RP, McManus AC (1994) Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study. Spine 19:1611–1618CrossRefPubMed
3.
Legaye J, Duval-Beaupere G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103CrossRefPubMedPubMedCentral
4.
Lindh M (1989) Biomechanics of the lumbar spine. In: Nordin M, Frankel VH (eds) Philadelphia
5.
Farfan HF, Huberdeau RM, Dubow HI (1972) Lumbar intervertebral disc degeneration: the influence of geometrical features on the pattern of disc degeneration—a post mortem study. J Bone Joint Surg Am 54:492–510PubMed
6.
Bernhardt M, Bridwell KH (1989) Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine 14:717–721CrossRefPubMed
7.
Keller TS, Colloca CJ, Harrison DE, Moore RJ, Gunzburg R (2007) Muscular contributions to dynamic dorsoventral lumbar spine stiffness. Eur Spine J 16:245–254CrossRefPubMed
8.
Goel VK, Kong W, Han JS, Weinstein JN, Gilbertson LG (1993) A combined finite element and optimization investigation of lumbar spine mechanics with and without muscles. Spine 18:1531–1541CrossRefPubMed
9.
Lee JH, Kim KT, Suk KS, Lee SH, Jeong BO, Kim JS, Eoh JH, Kim YJ (2010) Analysis of spinopelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine (Phila Pa 1976) 35:E1386–E1391. doi:10.​1097/​BRS.​0b013e3181e88be6​ CrossRef
10.
Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y (1988) Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine 13:1317–1326CrossRefPubMed
11.
Jeon CH, Kim DJ, Kim SK, Lee HM, Park HJ (2006) Validation in the cross-cultural adaptation of the Korean version of the oswestry disability index. J Korean Med Sci 21:1092–1097CrossRefPubMedPubMedCentral
12.
13.
Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G (2006) Sagittal thoracic decompensation following long adult lumbar spinal instrumentation and fusion to L5 or S1: causes, prevalence, and risk factor analysis. Spine 31:2359–2366CrossRefPubMed
14.
Videbaek TS, Bunger CE, Henriksen M, Neils E, Christensen FB (2011) Sagittal spinal balance after lumbar spinal fusion: the impact of anterior column support results from a randomized clinical trial with an eight- to thirteen-year radiographic follow-up. Spine 36:183–191. doi:10.​1097/​BRS.​0b013e3181cc8fce​ PubMed
15.
Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM (1999) Complications and predictive factors for the successful treatment of flatback deformity (fixed sagittal imbalance). Spine 24:1712–1720CrossRefPubMed
16.
Lee CS, Lee CK, Kim YT, Hong YM, Yoo JH (2001) Dynamic sagittal imbalance of the spine in degenerative flat back: significance of pelvic tilt in surgical treatment. Spine 26:2029–2035CrossRefPubMed
17.
Legaye J, Duval-Beaupere G (2005) Sagittal plane alignment of the spine and gravity: a radiological and clinical evaluation. Acta Orthop Belg 71:213–220PubMed
18.
Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 87:260–267CrossRefPubMed
19.
20.
Rose PS, Bridwell KH, Lenke LG, Cronen GA, Mulconrey DS, Buchowski JM, Kim YJ (2009) Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine 34:785–791CrossRefPubMed
21.
Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G (2006) An analysis of sagittal spinal alignment following long adult lumbar instrumentation and fusion to L5 or S1: can we predict ideal lumbar lordosis? Spine 31:2343–2352CrossRefPubMed
22.
Boulay C, Tardieu C, Hecquet J, Benaim C, Mouilleseaux B, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupere G, Pelissier J (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15:415–422. doi:10.​1007/​s00586-005-0984-5 CrossRefPubMed
23.
24.
25.
26.
Zhu Z, Sha S, Liu Z, Sun X, Jiang L, Yan H, Qian B, Qiu Y (2014) Sagittal spinopelvic alignment in adolescent thoracic scoliosis secondary to Chiari I malformation: a comparison between the left and the right curves. Eur Spine J 23:226–233. doi:10.​1007/​s00586-013-2980-5 CrossRefPubMed
27.
Lee CS, Chung SS, Park SJ, Kim DM, Shin SK (2014) Simple prediction method of lumbar lordosis for planning of lumbar corrective surgery: radiological analysis in a Korean population. Eur Spine J 23:192–197. doi:10.​1007/​s00586-013-2895-1 CrossRefPubMed
28.
Lee CS, Chung SS, Shin SK, Park JC, Kang KJ (2009) Analysis of surgical correction in lumbar degenerative kyphosis. The 26th fall congress. The Korean Society of spine surgery
29.
Jang JS, Lee SH, Min JH, Han KM (2007) Lumbar degenerative kyphosis: radiologic analysis and classifications. Spine 32:2694–2699CrossRefPubMed
30.
Horton WC, Brown CW, Bridwell KH, Glassman SD, Suk SI, Cha CW (2005) Is there an optimal patient stance for obtaining a lateral 36” radiograph? A critical comparison of three techniques. Spine 30:427–433CrossRefPubMed
31.
Glattes RC, Bridwell KH, Lenke LG, Kim YJ, Rinella A, Edwards C 2nd (2005) Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis. Spine 30:1643–1649CrossRefPubMed
32.
Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 30:682–688CrossRefPubMed
33.
Ondra SL, Marzouk S, Koski T, Silva F, Salehi S (2006) Mathematical calculation of pedicle subtraction osteotomy size to allow precision correction of fixed sagittal deformity. Spine 31:E973–E979CrossRefPubMed
34.
Smith JS, Bess S, Shaffrey CI, Burton DC, Hart RA, Hostin R, Klineberg E (2012) Dynamic changes of the pelvis and spine are key to predicting postoperative sagittal alignment after pedicle subtraction osteotomy: a critical analysis of preoperative planning techniques. Spine 37:845–853. doi:10.​1097/​BRS.​0b013e31823b0892​ CrossRefPubMed
35.
Lafage V, Ames C, Schwab F, Klineberg E, Akbarnia B, Smith J, Boachie-Adjei O, Burton D, Hart R, Hostin R, Shaffrey C, Wood K, Bess S (2012) Changes in thoracic kyphosis negatively impact sagittal alignment after lumbar pedicle subtraction osteotomy: a comprehensive radiographic analysis. Spine 37:E180–E187. doi:10.​1097/​BRS.​0b013e318225b926​ CrossRefPubMed
36.
Blondel B, Schwab F, Bess S, Ames C, Mummaneni PV, Hart R, Smith JS, Shaffrey CI, Burton D, Boachie-Adjei O, Lafage V (2013) Posterior global malalignment after osteotomy for sagittal plane deformity: it happens and here is why. Spine 38:E394–E401. doi:10.​1097/​BRS.​0b013e3182872415​ CrossRefPubMed
37.
Metadata
Title
Overcorrection of lumbar lordosis for adult spinal deformity with sagittal imbalance: comparison of radiographic outcomes between overcorrection and undercorrection
Authors
Jung-Hee Lee
Ki-Tack Kim
Sang-Hun Lee
Kyung-Chung Kang
Hyun-Seok Oh
Young-Jun Kim
Hyuk Jung
Publication date
01-08-2016
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 8/2016
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-016-4441-4

Other articles of this Issue 8/2016

European Spine Journal 8/2016 Go to the issue

Original Article

Postoperative dysesthesia in lumbar three-column resection osteotomies

Erratum

Erratum to: The prognostic ability of the STarT Back Tool was affected by episode duration

Ideas and Technical Innovations

Novel posterior technique to temporize life-threatening hemorrhage after great vessel laceration during posterior osteotomy

Original Article

Risk of revision surgery for adult idiopathic scoliosis: a survival analysis of 517 cases over 25 years

Original Article

Ratio of lumbar 3-column osteotomy closure: patient-specific deformity characteristics and level of resection impact correction of truncal versus pelvic compensation

Original Article

Walking sagittal balance correction by pedicle subtraction osteotomy in adults with fixed sagittal imbalance