Factors related to postoperative coronal imbalance in adult lumbar scoliosis

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  • 1 Department of Orthopaedic Surgery, Osaka City General Hospital; and
  • 2 Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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OBJECTIVE

The object of this study was to analyze the prevalence of postoperative coronal imbalance (CIB) and related factors in patients with adult lumbar scoliosis.

METHODS

This was a retrospective single-center study of data from patients with adult spinal deformity (ASD) who had undergone corrective surgery performed by a single surgeon between 2009 and 2017. The inclusion criteria were as follows: 1) age at surgery > 40 years, 2) Cobb angles of the thoracolumbar/lumbar (TL/L) curve > 40°, 3) upper instrumented vertebra of T9 or T10, 4) lowest instrumented vertebra of L5 or the pelvis, and 5) minimum 2-year follow-up period. Radiographic parameters were measured before surgery, 2 weeks after surgery, and at the latest follow-up. Curve flexibility was also assessed using side bending radiographs. Clinical outcomes were evaluated using the 22-Item Scoliosis Research Society Outcomes Questionnaire (SRS-22) and the SF-36. CIB was considered to have occurred if the C7 plumbline was more than 2.5 cm lateral to the central sacral vertical line (i.e., coronal vertical axis [CVA] > 2.5 cm) at the final follow-up. Parameters between the patients with (CIB group) and without (coronal balance [CB] group) CIB were compared, and factors related to CIB were evaluated.

RESULTS

From among 66 consecutively treated ASD patients, a total of 37 patients (mean age at surgery 66.3 years, average follow-up 63 months) met the study inclusion criteria. CIB was found in 6 patients at the final follow-up (16.2%), and the CVA of all patients in the CIB group shifted to the convex side of the TL/L curve. A comparative analysis between the CB and CIB groups, respectively, at the final follow-up indicated the following factors were related to CIB: lumbosacral (LS) curve, 11.0°/16.5° (p = 0.02); LS correction rate (CR), 61%/47% (p = 0.02); and CR ratio (LS vs TL/L), 0.93/0.67 (p = 0.0002). Regarding clinical outcomes, the satisfaction domain of the SRS-22 (CB 4.4 vs CIB 3.5) showed a significant difference between the CIB and CB groups (p = 0.02), and patients in the CB group tended to score better on the pain domain (CB 4.3 vs CIB 3.7), but the difference was not significant (p = 0.06).

CONCLUSIONS

Postoperative CIB negatively impacted patients’ HRQOL. An imbalanced correction ratio between the TL/L and LS curves may cause postoperative CIB. Therefore, adequate correction of the LS curve may prevent postoperative CIB.

ABBREVIATIONS AdLS = adult lumbar scoliosis; ASD = adult spinal deformity; BCR = bending CR; CB = coronal balance; CIB = coronal imbalance; CR = correction rate; CSVL = central sacral vertical line; CVA = coronal vertical axis; HRQOL = health-related quality of life; LIV = lowest instrumented vertebra; LL = lumbar lordosis; LS = lumbosacral; MCS = mental component summary; PCS = physical component summary; PI = pelvic incidence; PT = pelvic tilt; SRS = Scoliosis Research Society; SRS-22 = 22-Item SRS Outcomes Questionnaire; SVA = sagittal vertical axis; TK = thoracic kyphosis; TLK = thoracolumbar kyphosis; TL/L = thoracolumbar/lumbar.

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Contributor Notes

Correspondence Akira Matsumura: Osaka City General Hospital, Osaka, Japan. amatsumura@med.osaka-cu.ac.jp.

INCLUDE WHEN CITING Published online September 4, 2020; DOI: 10.3171/2020.6.SPINE20670.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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