Radiographic outcomes following surgical correction for lumbar degenerative kyphosis: the impact of supine pelvic tilt

Jae-Koo Lee Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam;

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Do-Hyoung Kim Department of Neurosurgery, Spine Center, Yonsei Okay Hospital, Uijeongbu-si, Gyeonggi-do; and

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Seung-Jae Hyun Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam;

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Seung Heon Yang Department of Neurosurgery, Spine Center, Seoul Barun Hospital, Seoul, Republic of Korea

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Ki-Jeong Kim Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam;

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OBJECTIVE

Lumbar degenerative kyphosis (LDK), a flexible deformity, is a common form of sagittal imbalance in Asian countries. Assessing a patient’s spine prior to surgery by using positional radiographs is becoming more crucial in determining surgical planning to achieve favorable clinical and radiographic outcomes, especially in patients with flexible deformities. This study aims to identify radiographic characteristics of supine pelvic tilt (sPT) and its relation to mechanical failure (MF) following LDK correction.

METHODS

A single-center, single-surgeon retrospective analysis was performed in patients who underwent LDK correction with sacropelvic fixation between January 2014 and May 2019. Patients were grouped into pelvic match and mismatch groups according to the difference between postoperative pelvic tilt (PT) and sPT. Demographic, surgical, and radiographic parameters were compared. Chronological change of PT was assessed by comparing preoperative, supine, immediate postoperative, and final PT.

RESULTS

Baseline demographics and sagittal alignments were similar between PT match (n = 25) and mismatch (n = 42) groups (p > 0.05). There was a significant difference in the rate of MF between PT match and mismatch groups (4% vs 31%, p = 0.021). Multivariable analysis demonstrated that after including control variables, PT mismatch was independently associated with the likelihood of MF development (OR 33.42, p = 0.04).

CONCLUSIONS

sPT reflects postoperative PT changes; therefore, supine imaging may represent a tool that could be used for preoperative decision-making in patients with LDK or possibly those with flexible adult spinal deformity. PT mismatch > 10° or < 0° is a significant risk factor for MF following correction of LDK. Measurement of sPT would aid surgeons in optimal preoperative planning and in minimizing catastrophic MF following deformity correction surgery.

ABBREVIATIONS

ASD = adult spinal deformity; BMD = bone mineral density; BMI = body mass index; ICC = interclass correlation coefficient; LDK = lumbar degenerative kyphosis; LL = lumbar lordosis; MF = mechanical failure; mPT = modified pelvic tilt; PCO = posterior column osteotomy; PI = pelvic incidence; PI-LL = pelvic incidence–lumbar lordosis mismatch; PT = pelvic tilt; SAAS = sagittal age-adjusted score; SPR = scan projection radiograph; sPT = supine PT; SRS = Scoliosis Research Society; SS = sacral slope; SVA = sagittal vertical axis; TK = thoracic kyphosis; T1PA = T1 pelvic angle; UIV = upper instrumented vertebra.
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Illustration from Lee et al. (pp 132–142). © Jae-Koo Lee, published with permission.

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