Characteristics and standards of severe sagittal imbalance in adult patients with spinal deformities: a retrospective analysis
Abstract Objective To analyze the characteristics of “severe” dynamic sagittal imbalance (DSI) in patients with adult spinal deformity (ASD) and establish criteria for them. Methods We retrospectively analyzed 102 patients with ASD presenting four cardinal signs of lumbar degenerative kyphosis. All...
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BMC
2024-02-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-024-07231-5 |
| _version_ | 1797276189136519168 |
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| author | Yong-Chan Kim Kee-Yong Ha Sung-Min Kim Xiongjie Li Dong-Hyun Kim |
| author_facet | Yong-Chan Kim Kee-Yong Ha Sung-Min Kim Xiongjie Li Dong-Hyun Kim |
| author_sort | Yong-Chan Kim |
| collection | DOAJ |
| description | Abstract Objective To analyze the characteristics of “severe” dynamic sagittal imbalance (DSI) in patients with adult spinal deformity (ASD) and establish criteria for them. Methods We retrospectively analyzed 102 patients with ASD presenting four cardinal signs of lumbar degenerative kyphosis. All patients underwent deformity corrective surgery and were divided into three groups according to the diagnostic criteria based on the Oswestry disability index and dynamic features (△Timewalk: time until C7 sagittal vertical axis [C7SVA] reaches ≥ 20 cm after the start of walking) of sagittal imbalance. The paravertebral back muscles were analyzed and compared using T2-weighted axial imaging. We performed a statistically time-dependent spinopelvic sagittal parameter analysis of full standing lateral lumbar radiographs. Lumbar flexibility was analyzed using dynamic lateral lumbar radiography. Results The patients were classified into the mild (△Timewalk ≥ 180 s, 35 patients), moderate (180 s > △Timewalk ≥ 30 s, 38 patients), and severe (△Timewalk < 30 s, 29 patients) groups. The back muscles in the severe group exhibited a significantly higher signal intensity (533.4 ± 237.5, p < 0.05) and larger area of fat infiltration (35.2 ± 5.4, p < 0.05) than those in the mild (223.8 ± 67.6/22.9 ± 11.9) and moderate groups (294.4 ± 214.7/21.6 ± 10.6). The analysis of lumbar flexibility revealed significantly lower values in the severe group (5.8° ± 2.5°, p < 0.05) than in the mild and moderate groups (14.2° ± 12.4° and 11.4° ± 8.7°, respectively). The severe group had significantly lower lumbar lordosis (LL, 25.1° ± 22.7°, p < 0.05) and Pelvic incidence-LL mismatch (PI-LL, 81.5° ± 26.6°, p < 0.001) than those of the mild (8.2° ± 16.3°/58.7° ± 18.8°) and moderate (14.3° ± 28.6°/66.8° ± 13.4°) groups. On receiver operating characteristic curve analysis, PI-LL was statistically significant, with an area under the curve of 0.810 (95% confidence interval) when the baseline was set at 75.3°. The severe group had more postoperative complications than the other groups. Conclusions Our results suggest the following criteria for severe DSI: C7SVA > 20 cm within 30 s of walking or standing, a rigid lumbar curve < 10° on dynamic lateral radiographs, and a PI-LL mismatch > 75.3°. Level of evidence 3. |
| first_indexed | 2024-03-07T15:24:48Z |
| format | Article |
| id | doaj.art-688d5a289fb0441c9fbd0fb131299f26 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-07T15:24:48Z |
| publishDate | 2024-02-01 |
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| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-688d5a289fb0441c9fbd0fb131299f262024-03-05T17:24:13ZengBMCBMC Musculoskeletal Disorders1471-24742024-02-0125111010.1186/s12891-024-07231-5Characteristics and standards of severe sagittal imbalance in adult patients with spinal deformities: a retrospective analysisYong-Chan Kim0Kee-Yong Ha1Sung-Min Kim2Xiongjie Li3Dong-Hyun Kim4Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at GangdongDepartment of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at GangdongDepartment of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at GangdongDepartment of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at GangdongDepartment of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at GangdongAbstract Objective To analyze the characteristics of “severe” dynamic sagittal imbalance (DSI) in patients with adult spinal deformity (ASD) and establish criteria for them. Methods We retrospectively analyzed 102 patients with ASD presenting four cardinal signs of lumbar degenerative kyphosis. All patients underwent deformity corrective surgery and were divided into three groups according to the diagnostic criteria based on the Oswestry disability index and dynamic features (△Timewalk: time until C7 sagittal vertical axis [C7SVA] reaches ≥ 20 cm after the start of walking) of sagittal imbalance. The paravertebral back muscles were analyzed and compared using T2-weighted axial imaging. We performed a statistically time-dependent spinopelvic sagittal parameter analysis of full standing lateral lumbar radiographs. Lumbar flexibility was analyzed using dynamic lateral lumbar radiography. Results The patients were classified into the mild (△Timewalk ≥ 180 s, 35 patients), moderate (180 s > △Timewalk ≥ 30 s, 38 patients), and severe (△Timewalk < 30 s, 29 patients) groups. The back muscles in the severe group exhibited a significantly higher signal intensity (533.4 ± 237.5, p < 0.05) and larger area of fat infiltration (35.2 ± 5.4, p < 0.05) than those in the mild (223.8 ± 67.6/22.9 ± 11.9) and moderate groups (294.4 ± 214.7/21.6 ± 10.6). The analysis of lumbar flexibility revealed significantly lower values in the severe group (5.8° ± 2.5°, p < 0.05) than in the mild and moderate groups (14.2° ± 12.4° and 11.4° ± 8.7°, respectively). The severe group had significantly lower lumbar lordosis (LL, 25.1° ± 22.7°, p < 0.05) and Pelvic incidence-LL mismatch (PI-LL, 81.5° ± 26.6°, p < 0.001) than those of the mild (8.2° ± 16.3°/58.7° ± 18.8°) and moderate (14.3° ± 28.6°/66.8° ± 13.4°) groups. On receiver operating characteristic curve analysis, PI-LL was statistically significant, with an area under the curve of 0.810 (95% confidence interval) when the baseline was set at 75.3°. The severe group had more postoperative complications than the other groups. Conclusions Our results suggest the following criteria for severe DSI: C7SVA > 20 cm within 30 s of walking or standing, a rigid lumbar curve < 10° on dynamic lateral radiographs, and a PI-LL mismatch > 75.3°. Level of evidence 3.https://doi.org/10.1186/s12891-024-07231-5Adult spinal deformityDegenerative flat backDynamic sagittal imbalanceDiagnostic criteriaSeverity |
| spellingShingle | Yong-Chan Kim Kee-Yong Ha Sung-Min Kim Xiongjie Li Dong-Hyun Kim Characteristics and standards of severe sagittal imbalance in adult patients with spinal deformities: a retrospective analysis BMC Musculoskeletal Disorders Adult spinal deformity Degenerative flat back Dynamic sagittal imbalance Diagnostic criteria Severity |
| title | Characteristics and standards of severe sagittal imbalance in adult patients with spinal deformities: a retrospective analysis |
| title_full | Characteristics and standards of severe sagittal imbalance in adult patients with spinal deformities: a retrospective analysis |
| title_fullStr | Characteristics and standards of severe sagittal imbalance in adult patients with spinal deformities: a retrospective analysis |
| title_full_unstemmed | Characteristics and standards of severe sagittal imbalance in adult patients with spinal deformities: a retrospective analysis |
| title_short | Characteristics and standards of severe sagittal imbalance in adult patients with spinal deformities: a retrospective analysis |
| title_sort | characteristics and standards of severe sagittal imbalance in adult patients with spinal deformities a retrospective analysis |
| topic | Adult spinal deformity Degenerative flat back Dynamic sagittal imbalance Diagnostic criteria Severity |
| url | https://doi.org/10.1186/s12891-024-07231-5 |
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