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Sagittal balance in thoracolumbar or lumbar
congenital kyphoscoliosis and kyphosisat a minimum of 10 years after surgery
: A case series
Miyazaki S, Suzuki T, Inui Y, Kawakita K
Dogaki Y, Kurakawa T, Uno K
9th ICEOS Annual Meeting, Boston, November 19-20 in 2015
Department of Orthpaedic Surgery National Hospital Organization Kobe Medical Center
DisclosureDisclosureAuthor
Relationships Disclosed
Miyazaki SSuzuki TInui YKawakita KDogaki YKurakawa TUno K
No RelationshipNo RelationshipNo RelationshipNo RelationshipNo RelationshipNo RelationshipNo Relationship
Postoperative sagittal balance in congenital kyphoscoliosis and kyphosis remain unclear.
The restoration of proper sagittal alignment is crucial for obtaining satisfactory clinical outcome in adult spinal deformity.
BackgroundBackground
Glassman SD, et al. SPINE 2005
ObjectiveObjective
To elucidate sagittal balance inthoracolumbar or lumbar congenital kyphoscoliosis and kyphosis
at a minimum of 10 years follow-upafter surgery
To elucidate sagittal balance inthoracolumbar or lumbar congenital kyphoscoliosis and kyphosis
at a minimum of 10 years follow-upafter surgery
MaterialsMaterials16 cases A retrospective analysis of the patients with
congenital kyphoscoliosis and kyphosis
Age (y.o.) : Gender (boy :girl) :
6 :10
10.1 ± 3.6
Vertebral anomalies
At initial surgery
Duration of follow-up (years) : 16.3 ± 4.0
Solitary simple Multiple simpleComplex
6 cases
7 cases3 cases
Kawakami N, et al. SPINE 2009
Posterior only
13 cases
Anterior + Posterior
3 cases
Surgical proceduresSurgical procedures16 cases
Additional Surgery 8 cases
✓Pseudoarthrosis✓Adjacent segmental disease✓Coronal decompensation✓Sagittal decompensation
1 case
1 case 1 case
✓Implant failure
2 cases 3 cases
Number of fused segment: 1.3 above and 1.3 below
Extension of fused segment
Radiological evaluationsRadiological evaluations
C7 Plumb line
C7 Plumb line
CSVL
Coronal plane
Sagittal plane
✓ Cobb angle of main curve
✓ Coronal balance
✓ Segmental angle of kyphosis
✓ Lumbar lordosis (LL)the angle between the lower endplate of LIV and the upper endplate of S1
✓ Sagittal vertical axis (SVA)
✓ Pelvic incidence (PI)
✓ Pelvic tilt (PT)
✓ Sacral slope (SS)
Results (Overall)Results (Overall)Pre OP Post OP Latest
Main curve 55.1±16.7 32.8±17.1 34.8±13.4
Coronal balance -9.8±17.1 3.3±18.6 4.2±8.8
Kyphosis 33.9±20.1 15.7±18.3 16.4±21.8
LL 44.5±28.0 37.1±22.4 34.7±19.1
SVA 13.1±33.8 18.4±22.2 33.8±57.1
PT 17.3±14.0 18.5±10.1 22.9±13.9
SS 28.5±9.2 28.1±7.3 23.7±11.7
✓Proximal junctional kyphosis (PJK)
✓Progression of the kyphosis
Cases of sagittal imbalanceCases of sagittal imbalanceshowed more than 40 mm of SVA at latest follow-up and more than 30 mm positive shift of SVA during follow-up period.
Pre OP Post OP Latest
Kyphosis 50.8±15.5 30.4±14.1 25.6±19.7
LL 41.8±45.3 32.4±39.5 17.0±17.6
PT 25.2±8.6 25.8±5.4 37.4±7.4
p<0.05*
*
*
*
*
*
1 case 2 cases
5 cases
Post 2nd OP 15 years
Post 2nd OP 7 years
Post 2nd OP
34°
C7 Plumb line
+38 mm +27
16°
+105
21°
17°
+30
28°
17°
78°
65°
Th12
L1
Illustrative case reportPre OP
(4 years old)
28° 45°35°24°
Kyphosis
LL
PT
SVA
DiscussionDiscussion
PJK
LL
PT
Pre OP Post OP
Mobile segment
Compensation Decompensation
Degeneration
✓ The development of secondary changes could be avoided only by early and complete correction of the local deformity.
Ruf M, Harms J. SPINE 2009 Our study
Sagittal imbalance
Considering re-operation with extension of fused segment
Residual kyphosis
Kyphosis Rigid & structural
ConclusionConclusion
Postoperative sagittal balance in thoracolumbar or lumbarcongenital kyphoscoliosis and kyphosis could deteriorate due to residual kyphosis and decompensation in the sagittal plane despite the early correction and short fusion.