Figure 1 - uploaded by Carlos Eduardo Barsotti
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Example of a digitalized image with measurements of the radiographic parameters of interest (SVA, PI, SS, PT, LL, and TK) using Surgimap Spine software (Nemaris Inc. New York, USA).
Source publication
Objective:
Evaluates which radiographic parameters of the sagittal and spinopelvic balance influence the clinical and functional outcomes of a sample of patients undergoing spinal fusion.
Methods:
We studied 32 patients who underwent spinal fusion. Radiographs of the total spine were obtained from all patients. The clinical and functional paramete...
Context in source publication
Context 1
... The digitalized images obtained were ana- lyzed using Surgimap Spine software (Nemaris Inc. New York, USA) to measure the following radiographic global sagittal and spinopelvic alignment parameters: sagittal vertical axis (SVA), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), thoracic kyphosis (TK), and lumbar lordosis (LL) as illustrated in Figure 1. We also calculated the difference between PI and LL (PI-LL). ...
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Objective:
This study aimed to determine whether surgery leads to changes in sagittal balance in patients with congenital scoliosis.
Methods:
We retrospectively reviewed all cases of scoliosis operated in a tertiary hospital between January 2009 and January 2013. In all cases the deformity in the coronal and sagittal planes, kyphosis, and lordosis...
Citations
... The published studies on functional outcome and SPA after spinal surgery have offered conflicting results. A number of studies have established a significant relationship between these parameters and outcomes, while others were unable to establish a relationship, even with positive outcomes, while these measurements were abnormal [2,3,7,10,12,[14][15][16]. This inconsistency may be due to other factors contributing to the outcome not being studied or due to the short follow-up procedures. ...
Objective:
A normal age-adjusted sagittal alignment is an important factor in achieving long-term functional results after lumbar spinal fusion. We aim to determine if the changes in spino-pelvic alignment (SPA) correlate with post-operative functional outcomes in patients who underwent instrumented lumbar spine surgery when the parameters were not measured before.
Method:
A retrospective review of medical records from 2012 to 2016, and radiographs of the patients who underwent instrumented fusion of the lumbar spine. The X-rays of the available preoperative lumbar spine were reviewed for SPA and compared with the last follow-up postoperative images. The patients were contacted by telephone to complete the EuroQoL 5 Dimensions 5-level questionnaire and visual analog scale for evaluation of their functional outcomes during 2017. Correlation studies were performed using Pearson's coefficient.
Results:
Forty-six patients were included with a mean age of 53 years and a follow-up of 47 months. There was a significant improvement in the functional outcomes and pain in the whole group. All the patients showed improvement in their SPA, and those who underwent more than two levels of fusion showed a significant improvement (P<0.05). Lumbar lordosis and sacral slope had a significant correlation with postoperative clinical improvement (R=0.8).
Conclusion:
The study showed that single or double fusion has significant improvement in pain and functional outcome with a significant change in SPA.
... Coutinho et al. aimed to explore which sagittal and spinopelvic radiographic parameters more influences the clinical and functional outcomesof patients undergoing spinal fusion. According to their results, patients' satisfaction was significantly correlated with SVA, but not PT and PI-LL (12). This inconsistency with our results could be attributed to the different followup periods of the studies. ...
Background:
Sagittal imbalance is known as the main radiographic driver of disability in adult spinal deformity (ASD). In this study, the association of radiological spinopelvic parameters and clinical outcomes was evaluated following the corrective surgery of sagittal imbalance, in order to explore the predictive ability of each parameter.
Methods:
A total of 23 patients, who underwent corrective osteotomy for restoration of sagittal balance, were included in this study. The mean follow-up period of the patients was 15.5±2.1, ranging from 12 to 18 months. Pre- and postoperative radiological parameters including pelvic tilt (PT), sagittal vertical axis (SVA) and pelvic incidence minus lumbar lordosis (PI-LL) were assessed for each patient. Clinical outcomes were evaluated using Oswestry disability Index (ODI).
Results:
The mean ODI improved 32% following the corrective osteotomy of sagittal imbalance. Postoperative ODI was significantly correlated with all preoperative radiological parameters (r=0.608, P=0.002 for PI-LL; r=0.483, P=0.01 for PT; and r=0.464, P=0.02 for SVA). ODI improvement was significantly correlated with PI-LL and SVA change (r=536, P=0.008 and r=416, P=0.04, respectively), but not with PT change (r=247, P=0.25). The outcome was better in pedicle subtraction osteotomy (PSO) compared to Smith-Petersen Osteotomy (SPO).
Conclusion:
Surgical correction of sagittal imbalance could limit the amount of disability caused by this misalignment. According to our results, while all the spinopelvic parameters could be used in the prediction of the outcomes of corrective surgery of sagittal imbalance, PI-LL was the most informative parameter and more attention should be devoted to this parameter.
... The spinopelvic morphology modulates the lumbosacral configuration and consequently, the mechanical stress at the lumbosacral junction. Restoration of the sagittal balance has been emphasized recently (33,54) and it has been shown to directly impact both the standing balance and clinical outcomes of the patients (54,55). Kawakami et al (56) studied whether lumbar sagittal balance affected the clinical outcome after PLF and they concluded that SVA (center in the L1 to the back corner of the S1) should be considered in the choice of treatment strategy when PLF is indicated for patients with degenerative lumbar spondylolisthesis. ...
Background:
Degenerative lumbar spine disease can lead to lumbar spine instability. Lumbar spine instability is defined as an abnormal response to applied loads characterized kinematically by abnormal movement in the motion segment beyond normal constraints. Patients with lumbar spinal stenosis (LSS) typically present with low back pain (LBP), cramping, cauda equine syndrome, and signs of nerve root compression associated by weakness, numbness and tingling in their legs that are worsened with standing and walking. This degenerative condition severely restricts function, walking ability, and quality of life (QOL).
Objectives:
This study aims to compare clinical and radiological outcomes of posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF) with posterior instrumentation in the treatment of LSS and degenerative instability.
Study design:
A randomized prospective controlled clinical study.
Methods:
In this prospective study, 88 patients with LSS and degenerative instability were randomly allocated to one of 2 groups: PLF (Group I) or PLIF (Group II). Primary outcomes were the control of LBP and radicular pain, evaluated with visual analog scale (VAS), the improvement of QOL assessed by the Oswestry disability index (ODI) scale, and measurement of fusion rate, Cobb angle, spinal sagittal balance, and modic changes in the 2 groups.
Results:
At 24 months postoperatively, the mean reduction in VAS scores in Group I was more than in Group II (5.67 vs. 5.48, respectively) and the patients in Group I had more improvement in the ODI score than the patients in Group II (42.75 vs. 40.94, respectively). There was a statistically significant difference between the preoperative and postoperative sagittal balance in the 2 groups. The mean Cobb angle changed significantly in the 2 groups.
Limitations:
There are few prospective studies of PLIF or PLF in patients with LSS and degenerative lumbar spine instability, and a limited number of studies which exists have examined the safety and outcome of each procedure without comparing it with other fusion techniques. Because most of the studies in the literature have been conducted in the patients with IS, we could not compare and contrast our findings with studies in patients with LSS and degenerative lumbar spine instability. In addition, although in our study the findings at a 24-month follow-up period showed that PLF was better than PLIF in these patients, there were some studies in which the authors reported that PLIF showed better clinical results than PLF at a 48-month follow-up period. So we suggest that rigorous controlled trials at longer follow-up periods should be undertaken in groups of patients with LSS and degenerative lumbar spine instability who undergo posterior decompression and instrumented fusion to help to determine the ultimate best fusion technique for these patients.
Conclusion:
PLF with posterior instrumentation provides better clinical outcomes and improvement in the LBP, radicular pain, and functional QOL, more correction of the Cobb angle, more restoration of sagittal alignment, more decrease in Modic type 1, and more increase in Modic type 0, despite the low fusion rate compared to PLIF.
Key words:
Lumbar spinal stenosis, degenerative instability, posterolateral fusion, posterior lumbar interbody fusion, low back pain, quality of life, cobb angle, fusion rate, modic changes, sagittal balance.
... The spino-pelvic parameters are key components in the evaluation and treatment of sagittal deformities 9 and also of degenerative pathologies of the spine, as correct sagittal alignment directly impacts the quality of life of these patients. 13,14 The current standard for acquiring the measurements uses manual measuring of these parameters with a goniometer, a process that requires a dermatograph pencil for drawing lines on the radiographic film, as well as the goniometer itself, which the clinician many times does not have on hand. 15 Recently, with the inclusion of technological tools in medical practice, these technologies can be used to assist physicians in clinical practice. ...
Objective:
This study aims to evaluate the reliability and equivalency of using the Cobbmeter application for iPhone compared to the manual measurement method in the analysis of the sagittal spinal alignment.
Methods:
Cross-sectional, prospective, single-center study that had 20 panoramic radiographs of the spine in lateral view, in a neutral standing position, analyzed blindly and randomly by three independent examiners in three different times. The parameters were pelvic incidence (PI), pelvic tilt (PT) and lumbar lordosis (LL). The statistical analysis was performed to measure the intraclass correlation coefficient (ICC) between the two measurement methods, in addition to measuring the intra and inter-evaluators reliability.
Results:
For reproducibility analysis, the intra-evaluators ICC using the application resulted in a Kappa (K) of 0.975 for the evaluation of pelvic incidence (PI) evaluation. For pelvic tilt (PT), the K value obtained was 0.981 and the K measured for lumbar lordosis (LL) analysis was 0.987. The inter-evaluators evaluation of reproducibility using the application resulted in a K value of 0.917 for PI, 0.930 for PT and 0.951 for LL. For the assessment of equivalency of methods, comparing the application to the standard method, with a goniometer and dermographic pencil, the K value found for PI was 0.873, for PV was 0.939 and for LL was 0.914. All values were significant (p<0.001) against the null hypothesis.
Conclusion:
This smartphone application is a valid and reliable instrument for measuring the angle involved in the sagittal balance of the spine. Furthermore, the results show that its applicability is not inferior to the manual method with goniometer and dermographic pencil.
Objective: The prevalence of degenerative scoliosis (DS) increases with age and an overall increase is seen due to the aging population. This study aims to evaluate the clinical and radiological outcomes after decompression and posterior fusion in patients with DS.
Methods: In this is prospective study, 43 patients with DS, aged 37 to 70 years, were eligible to undergo decompression and posterior fusion. Primary outcomes were low back pain (LBP) with or without radicular pain, which was evaluated preoperatively and at 12 and 24 months after surgery with the use of a visual analog scale (VAS), and the quality of life (QOL), which was assessed at the same time periods by the Oswestry Disability Index (ODI) questionnaire. The Cobb's method was used to measure the degree of scoliosis in each patient preoperatively and at 24 hours, 12 and 24 months after the surgery.
Results: VAS scores improved significantly from a mean of 8.18 preoperatively to 4.48 at 12 months and 3.07 at 24 months postoperatively (P < .001). The mean radicular pain scores also decreased significantly (P < .001). At postoperative 12 months, the mean ODI score was significantly lower than the mean preoperative ODI score (47.81 ± 16.06 vs. 72.18 ± 12.28; P = .001). ODI score at 24 months postoperatively was significantly better than the preoperative ODI (15.53 ± 7.21 vs. 72.18 ± 12.28; P = .016). The mean Cobb angle changed significantly from 31.4° ± 4.88 preoperatively to 3.28° ± 2.10 at 24 months postoperatively (P < .001).
Conclusions: Our findings suggest that decompression and posterior fusion in the patients with DS is an effective surgical method which is associated with satisfying clinical results in terms of improvement of postoperative LBP, radicular pain, and QOL, and correction of Cobb angle at 12 and 24 months after the surgery and restoration of sagittal alignment at 2 months postoperatively.
