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Jiang Z, Liu Z, Li C, Fu X, Yu H, Wang X, Zhang M, Liu L, Cheng Y, Du W, Zhu R. The correction range of lumbosacral curve vertebral body tilt in degenerative scoliosis for achieving postoperative coronal balance. BMC Musculoskelet Disord 2025; 26:401. [PMID: 40264042 PMCID: PMC12016090 DOI: 10.1186/s12891-025-08655-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Accepted: 04/14/2025] [Indexed: 04/24/2025] Open
Abstract
PURPOSE To explore the relationship between lumbosacral curve vertebral body tilt correction and postoperative coronal balance in adult degenerative scoliosis to determine the ideal target values for the tilt correction. METHODS We conducted a retrospective analysis of 144 patients who underwent surgery between January 2017 and December 2023. Patients were classified based on the preoperative Obeid classification and fixation segment length into Concave Long Segment (Concave-L, n = 41), Concave Short Segment (Concave-S, n = 33), Convex Long Segment (Convex-L, n = 39), and Convex Short Segment (Convex-S, n = 31). Changes in coronal and sagittal radiographic parameters and the correlation between the correction percentage of the most tilted vertebra (L4 or L5) and postoperative coronal balance distance (CBD) were assessed. RESULTS Significant postoperative improvements in CBD, maximum coronal tilt, and Cobb angle were observed in the Concave-L, Convex-L, and Convex-S groups. The Concave-S group exhibited significant changes only in Cobb angle and maximum coronal tilt, but not CBD. A significant negative correlation existed between postoperative CBD and the correction ratio of maximum coronal tilt in the convex malalignment (r=-0.629, P < 0.001), with the regression equation: Postoperative CBD = 32.99 - (28.82 × Correction Ratio of Coronal Tilt). A correction ratio exceeding 45% at L4 or L5 tilt predicted a postoperative CBD within 20 mm. CONCLUSION Both short and long segment fusions effectively correct convex coronal malalignment, but concave malalignment requires long segment fusion for adequate correction. Optimal coronal balance in convex malalignment is achieved when the maximum tilt correction ratio exceeds 45%.
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Affiliation(s)
- Zehua Jiang
- Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Ziyang Liu
- Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
- Department of Orthopedics, Tianjin Hospital, Tianjin, China
| | - Chuanxu Li
- Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Xuanhao Fu
- Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China.
| | - Hao Yu
- Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Xuan Wang
- Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Maosen Zhang
- Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Linyan Liu
- Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Yuelin Cheng
- Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Wenjun Du
- Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China
| | - Rusen Zhu
- Department of Spine Surgery, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China.
- Tianjin Institute of Spinal Surgery, Tianjin, China.
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Zhang J, Liu Y, Zeng Y, Li W, Chen Z. Impact of postoperative spinal malalignment on postoperative health-related quality of life after long-level fixation for degenerative lumbar scoliosis: does residual coronal angularity matter? 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 2024; 33:3872-3879. [PMID: 39030321 DOI: 10.1007/s00586-024-08372-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/02/2024] [Accepted: 06/13/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE This study evaluates the influence of spinal malalignment on health-related quality of life (HRQOL) in a long-level fusion spine. METHODS This was a retrospective analysis of 121 consecutive patients with DLS after long-segment fusion. HRQOL and radiographic parameters were collected at final follow-up. For postoperative residual Cobb angle (CA), patients were divided as follows: group (0) (CA < 10°), group (+) (CA 10°∼20 °), and group (++) (CA > 20°). For postoperative coronal vertical axis (CVA), patients were separated as follows: group (0) (CVA < 2 cm), group (+) (CVA 2 ∼ 3 cm), and group (++) (CVA > 3 cm). Patients were also grouped by the sagittal modifiers as group (0), group (+), and group (++) according to the Scoliosis Research Society (SRS)-Schwab classification, respectively. RESULTS Visual analog scale (VAS) for back was significantly lower in CA 10°∼20° group compared to other groups. Patients with remnant CA > 20° showed worse Oswestry Disability Index (ODI), SRS-22 and the 36-item Short Form Health Survey (SF-36) - physical component scores (PCS). Sagittal vertical axis (SVA) showed significant correlation with HRQOLs after surgery, and the statistical significance of ODI, SRS-22 and SF-36 scores was observed among subgroups. CONCLUSIONS In long-level fused spine, residual CA > 20° resulted in worse clinical outcomes and was recommended to avoid during surgery. And 10° to 20° residual CA was acceptable in DLS patients and even better than Cobb angle < 10° in several HRQOLs, therefore strictly pursing upright alignment seems unnecessary. SVA also showed effectiveness in assessing HRQOL in the fixed spine.
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Affiliation(s)
- Jiaqi Zhang
- Department of Orthopedics, Peking University Third Hospital, No. 49. North Garden Street, Hai Dian District, Beijing, 100191, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
| | - Yinhao Liu
- Department of Orthopedics, Peking University Third Hospital, No. 49. North Garden Street, Hai Dian District, Beijing, 100191, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
| | - Yan Zeng
- Department of Orthopedics, Peking University Third Hospital, No. 49. North Garden Street, Hai Dian District, Beijing, 100191, People's Republic of China.
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China.
| | - Weishi Li
- Department of Orthopedics, Peking University Third Hospital, No. 49. North Garden Street, Hai Dian District, Beijing, 100191, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
| | - Zhongqiang Chen
- Department of Orthopedics, Peking University Third Hospital, No. 49. North Garden Street, Hai Dian District, Beijing, 100191, People's Republic of China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, China
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Sharfman ZT, Clark AJ, Gupta MC, Theologis AA. Coronal Alignment in Adult Spine Surgery. J Am Acad Orthop Surg 2024; 32:417-426. [PMID: 38354413 DOI: 10.5435/jaaos-d-23-00961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/28/2023] [Indexed: 02/16/2024] Open
Abstract
Coronal realignment is an important goal in adult spine surgery that has been overshadowed by emphasis on the sagittal plane. As coronal malalignment drives considerable functional disability, a fundamental understanding of its clinical and radiographic evaluation and surgical techniques to prevent its development is of utmost importance. In this study, we review etiologies of coronal malalignment and their radiographic and clinical assessments, risk factors for and functional implications of postoperative coronal malalignment, and surgical strategies to optimize appropriate coronal realignment in adult spine surgery.
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Affiliation(s)
- Zachary T Sharfman
- From the Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, CA (Sharfman and Theologis), Department of Neurological Surgery, UCSF, San Francisco, CA (Clark), Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Gupta)
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