Spinal Deformity Surgery: A Critical Review of Alignment and Balance
Correction of the overall coronal and/or sagittal plane deformities is one of the main predictors of successful spinal surgery. In routine clinical practice, spinal alignment is assessed using several spinal and pelvic parameters, such as pelvic incidence and tilt, sacral slope, lumbar lordosis, tho...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Korean Spine Society
2018-08-01
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| Series: | Asian Spine Journal |
| Subjects: | |
| Online Access: | http://www.asianspinejournal.org/upload/pdf/asj-2018-12-4-775.pdf |
| _version_ | 1828530681294094336 |
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| author | Matthias Pumberger Hendrik Schmidt Michael Putzier |
| author_facet | Matthias Pumberger Hendrik Schmidt Michael Putzier |
| author_sort | Matthias Pumberger |
| collection | DOAJ |
| description | Correction of the overall coronal and/or sagittal plane deformities is one of the main predictors of successful spinal surgery. In routine clinical practice, spinal alignment is assessed using several spinal and pelvic parameters, such as pelvic incidence and tilt, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis. Standard values have been defined for all these parameters, and the formulas of correction have been set for determining the surgical strategy. However, several factors can potentially bias these formulas. First, all standard values are measured using conventional plain radiographs and are, therefore, prone to bias. The radiologist, measuring surgeon, and patient are possible confounding influencing factors. Second, spino-pelvic compensatory effects and biomechanically relevant structures for the patient’s posture, including ligaments, tendons, and muscles, have received minimal consideration in the literature. Therefore, even in cases of appropriately planned deformity correction surgeries, complications, revision rates, and surgical outcomes significantly vary. This study aimed to illustrate the current clinical weaknesses of the assessment of spinal alignment and the importance of holistically approaching the musculoskeletal system for any spinal deformity surgery. We believe that our detailed insights regarding spinal, sagittal, and coronal alignments as well as the considerations of an individual’s spinal balance will contribute toward improvement in routine patient care. |
| first_indexed | 2024-12-11T22:27:36Z |
| format | Article |
| id | doaj.art-5414c0b34deb41f78d49708246aac332 |
| institution | Directory Open Access Journal |
| issn | 1976-1902 1976-7846 |
| language | English |
| last_indexed | 2024-12-11T22:27:36Z |
| publishDate | 2018-08-01 |
| publisher | Korean Spine Society |
| record_format | Article |
| series | Asian Spine Journal |
| spelling | doaj.art-5414c0b34deb41f78d49708246aac3322022-12-22T00:48:15ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462018-08-0112477578310.31616/asj.2018.12.4.775931Spinal Deformity Surgery: A Critical Review of Alignment and BalanceMatthias Pumberger0Hendrik Schmidt1Michael Putzier2 Spine Department, Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany Julius Wolff Institute, Charité – Universitätsmedizin Berlin, Berlin, Germany Spine Department, Center for Musculoskeletal Surgery, Charité – Universitätsmedizin Berlin, Berlin, GermanyCorrection of the overall coronal and/or sagittal plane deformities is one of the main predictors of successful spinal surgery. In routine clinical practice, spinal alignment is assessed using several spinal and pelvic parameters, such as pelvic incidence and tilt, sacral slope, lumbar lordosis, thoracic kyphosis, and sagittal vertical axis. Standard values have been defined for all these parameters, and the formulas of correction have been set for determining the surgical strategy. However, several factors can potentially bias these formulas. First, all standard values are measured using conventional plain radiographs and are, therefore, prone to bias. The radiologist, measuring surgeon, and patient are possible confounding influencing factors. Second, spino-pelvic compensatory effects and biomechanically relevant structures for the patient’s posture, including ligaments, tendons, and muscles, have received minimal consideration in the literature. Therefore, even in cases of appropriately planned deformity correction surgeries, complications, revision rates, and surgical outcomes significantly vary. This study aimed to illustrate the current clinical weaknesses of the assessment of spinal alignment and the importance of holistically approaching the musculoskeletal system for any spinal deformity surgery. We believe that our detailed insights regarding spinal, sagittal, and coronal alignments as well as the considerations of an individual’s spinal balance will contribute toward improvement in routine patient care.http://www.asianspinejournal.org/upload/pdf/asj-2018-12-4-775.pdfSagittal balanceAdult spinal deformitySpinal surgerySpine biomechanics |
| spellingShingle | Matthias Pumberger Hendrik Schmidt Michael Putzier Spinal Deformity Surgery: A Critical Review of Alignment and Balance Asian Spine Journal Sagittal balance Adult spinal deformity Spinal surgery Spine biomechanics |
| title | Spinal Deformity Surgery: A Critical Review of Alignment and Balance |
| title_full | Spinal Deformity Surgery: A Critical Review of Alignment and Balance |
| title_fullStr | Spinal Deformity Surgery: A Critical Review of Alignment and Balance |
| title_full_unstemmed | Spinal Deformity Surgery: A Critical Review of Alignment and Balance |
| title_short | Spinal Deformity Surgery: A Critical Review of Alignment and Balance |
| title_sort | spinal deformity surgery a critical review of alignment and balance |
| topic | Sagittal balance Adult spinal deformity Spinal surgery Spine biomechanics |
| url | http://www.asianspinejournal.org/upload/pdf/asj-2018-12-4-775.pdf |
| work_keys_str_mv | AT matthiaspumberger spinaldeformitysurgeryacriticalreviewofalignmentandbalance AT hendrikschmidt spinaldeformitysurgeryacriticalreviewofalignmentandbalance AT michaelputzier spinaldeformitysurgeryacriticalreviewofalignmentandbalance |