Journal ArticleDOI
Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery.
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TLDR
Good clinical outcome requires achieving proper spinopelvic alignment in the treatment of adult spinal deformity, and restoring low sagittal vertical axis and pelvic tilt values are critical goals, and should be combined with proportional lumbar lordosis to pelvic incidence.Abstract:
Study design Current concepts review. Objective Outline the basic principles in the evaluation and treatment of adult spinal deformity patients with a focus on goals to achieve during surgical realignment surgery. Summary of background data Proper global alignment of the spine is critical in maintaining standing posture and balance in an efficient and pain-free manner. Outcomes data demonstrate the clinical effect of spinopelvic malalignment and form a basis for realignment strategies. Methods Correlation between certain radiographic parameters and patient self-reported pain and disability has been established. Using normative values for several important spinopelvic parameters (including sagittal vertical axis, pelvic tilt, and lumbar lordosis), spinopelvic radiographic realignment objectives were identified as a tool for clinical application. Because of the complex relationship between the spine and the pelvis in maintaining posture and the wide range of "normal" values for the associated parameters, a focus on global alignment, with proportionality of individual parameters to each other, was pursued to provide clinical relevance to planning realignment for deformity across a range of clinical cases. Conclusion Good clinical outcome requires achieving proper spinopelvic alignment in the treatment of adult spinal deformity. Although variations in pelvic morphology exist, a framework has been established to determine ideal values for regional and global parameter in an individualized patient approach. When planning realignment surgery for adult spinal deformity, restoring low sagittal vertical axis and pelvic tilt values are critical goals, and should be combined with proportional lumbar lordosis to pelvic incidence.read more
Citations
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Journal ArticleDOI
Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis.
Frank J. Schwab,Benjamin Blondel,Benjamin Blondel,Shay Bess,Richard A. Hostin,Christopher I. Shaffrey,Justin S. Smith,Oheneba Boachie-Adjei,Douglas C. Burton,Behrooz A. Akbarnia,Gregory M. Mundis,Christopher P. Ames,Khaled M. Kebaish,Robert A. Hart,J.-P. Farcy,Virginie Lafage +15 more
TL;DR: In this article, the authors evaluated correlations between spinopelvic parameters and health-related quality of life (HRQOL) scores in patients with spinal deformity and found that spinopels can provide a more complete assessment of the sagittal plane.
Journal ArticleDOI
The Comprehensive Anatomical Spinal Osteotomy Classification
Frank J. Schwab,Benjamin Blondel,Benjamin Blondel,Edward Chay,Jason Demakakos,Lawrence G. Lenke,Patrick Tropiano,Christopher P. Ames,Justin S. Smith,Christopher I. Shaffrey,Steven D. Glassman,Jean-Pierre Farcy,Virginie Lafage +12 more
TL;DR: This proposed anatomically based classification system provides a consistent description of the various osteotomies performed in spinal deformity correction surgery and will provide a common frame for osteotomy assessment and permit comparative analysis of different treatments.
Journal ArticleDOI
The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort.
Jamie S. Terran,Frank J. Schwab,Christopher I. Shaffrey,Justin S. Smith,Pierre Devos,Christopher P. Ames,Kai-Ming G. Fu,Douglas Burton,Richard A. Hostin,Eric O. Klineberg,Munish C. Gupta,Vedat Deviren,Gregory M. Mundis,Robert A. Hart,Shay Bess,Virginie Lafage +15 more
TL;DR: This study demonstrates that the SRS-Schwab classification reflects severity of disease state based on multiple measures of HRQOL and significantly correlates with the important decision of whether to pursue operative or nonoperative treatment.
Journal ArticleDOI
Global Alignment and Proportion (GAP) Score: Development and Validation of a New Method of Analyzing Spinopelvic Alignment to Predict Mechanical Complications After Adult Spinal Deformity Surgery.
Caglar Yilgor,Nuray Sogunmez,Louis Boissiere,Yasemin Yavuz,Ibrahim Obeid,Frank Kleinstück,Francisco Javier Sánchez Pérez-Grueso,Emre Acaroglu,Sleiman Haddad,Anne F. Mannion,Ferran Pellisé,Ahmet Alanay +11 more
TL;DR: The GAP score is a new pelvic-incidence-based proportional method of analyzing the sagittal plane that predicts mechanical complications in patients undergoing surgery for adult spinal deformity and may decrease the prevalence of mechanical complications.
Journal ArticleDOI
Impact of spinopelvic alignment on decision making in deformity surgery in adults: A review.
Christopher P. Ames,Justin S. Smith,Justin K. Scheer,Shay Bess,S. Samuel Bederman,Vedat Deviren,Virginie Lafage,Frank J. Schwab,Christopher I. Shaffrey +8 more
TL;DR: The proper analysis of spinopelvic alignment for surgical planning is described and the C-7 plumb line (sagittal vertical axis) has traditionally been used to evaluate sagittal spinal alignment; however, recent data indicate that the measurement of spino-spinal parameters provides a more comprehensive assessment.
References
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Journal ArticleDOI
The Impact of Positive Sagittal Balance in Adult Spinal Deformity
Steven D. Glassman,Keith H. Bridwell,John R. Dimar,William C. Horton,Sigurd Berven,Frank J. Schwab +5 more
TL;DR: This study shows that although even mildly positive sagittal balance is somewhat detrimental, severity of symptoms increases in a linear fashion with progressive sagittal imbalance, and shows that kyphosis is more favorable in the upper thoracic region but very poorly tolerated in the lumbar spine.
Journal ArticleDOI
Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves
TL;DR: An anatomical parameter, the pelvic incidence, appears to be the main axis of the sagittal balance of the spine, which controls spinal curves in accordance with the adaptability of the other parameters.
Journal ArticleDOI
Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position.
TL;DR: To describe, quantify, and classify common variations in the sagittal alignment of the spine, sacrum, and pelvis may help to discover the association between spinal balance and the development of degenerative changes in the spine.
Journal ArticleDOI
Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity.
TL;DR: This study confirms that pelvic position measured via PT correlates withHRQOL in the setting of adult deformity and demonstrates significant T1–SPI correlation with HRQOL measures and outperforms SVA.
Journal ArticleDOI
Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects.
TL;DR: The T9 sagittal offset, reflecting the sagittal balance of the spine, was dependent on three separate factors: a linear combination of the pelvic incidence, maximum lumbar lordosis, and sacral slope; the pelvic tilt; and the thoracic kyphosis.