Author:
Ding Linyao,Sun Zhuoran,Li Weishi,Zeng Yan,Chen Ze,Qiu Weipeng,Hou Xiangyu,Yuan Lei
Abstract
Study Design.
Retrospective radiographic study.
Objective.
To determine the potential risk factors influencing the transition of postoperative coronal balance in degenerative lumbar scoliosis (DLS) patients.
Summary of Background Data.
As time passes after surgery, the spinal sequence of DLS patients may dynamically shift from coronal balance to imbalance, causing clinical symptoms. However, the transition of postoperative coronal balance and its risk factors have not been effectively investigated.
Materials and Methods.
We included 156 DLS patients. The cohort was divided into immediate postoperative coronal balance with follow-up balance (N=73) and follow-up imbalance (N=21), immediate postoperative coronal imbalance (CIB) with follow-up balance (N=23), and follow-up imbalance (N=39). Parameters included age, sex, classification of coronal balance, coronal balance distance, fusion of L5 or S1, location of apical vertebra, apical vertebral translation (AVT), Cobb angle of the main curve and lumbar-sacral curve, tilt and direction of L4/5, tilt and direction of upper instrumented vertebra (UIV), and Cobb angle of T1-UIV. Statistical testing was performed using chi-square/Fisher exact test, t tests or nonparametric tests, correlation testing, and stepwise logistic regression.
Results.
We identified a significant difference in preoperative AVT, preoperative Cobb angle, and immediate postoperative UIV tilt between patients with and without follow-up balance. Logistic regression analysis demonstrated factors associated with follow-up CIB included preoperative AVT (P=0.015), preoperative Cobb angle (P=0.002), and tilt of immediate postoperative UIV (P=0.018). Factors associated with immediate postoperative CIB in patients with follow-up coronal balance were sex, correction ratio of the main curve, and direction of L4. Logistic regression analysis further identified a correction ratio of main curve ≤0.7 (P=0.009) as an important predictive factor.
Conclusion.
Patients with immediate postoperative coronal balance and higher preoperative AVT, preoperative Cobb angle, and tilt of immediate postoperative UIV were more likely to experience follow-up CIB. A correction ratio of the main curve ≤0.7 was an independent predictor of follow-up CIB.
Level of Evidence.
3.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Neurology (clinical),Orthopedics and Sports Medicine
Reference33 articles.
1. Adult scoliosis: surgical indications, operative management, complications, and outcomes;Bradford;Spine (Phila Pa 1976),1999
2. Outcome of surgery for degenerative lumbar scoliosis: An observational study using the Swedish Spine register;Cheng;Eur Spine J,2018
3. Scoliosis in adults aged forty years and older: Prevalence and relationship to age, race, and gender;Kebaish;Spine (Phila Pa 1976),2011
4. Adult lumbar scoliosis. Epidemiologic aspects in a low-back pain population;Pérennou;Spine (Phila Pa 1976),1994
5. The prevalence and radiological findings in 1347 elderly patients with scoliosis;Hong;J Bone Joint Surg Br,2010