Abstract
Aim: Maintaining coronal and sagittal balance is the main goal in surgeries for lumbar degenerative scoliosis. The balance created by proper alignment is closely related to the patient's postoperative quality of life and satisfaction. Surgical maneuvers in both planes are needed for sagittal and coronal balance. In this study, it was aimed to compare the effect of using single or double rods in the correction of coronal mismatch.
Method: A total of 22 patients (14 female and 8 male, mean age 64.3±10.3 years) diagnosed with lumbar degenerative scoliosis, who applied to our institution between January 2019 and December 2021, were included in the study. The patients were divided into two groups, the first group was determined as single rod (n:11) and the second group as double rod (n:11) patients. Pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), cobb angle, central sacral vertical line (CSVL), spinopelvic parameter measurements were made for each patient, including the T1 plumbline. In addition, the Visual Analog Scale (Visu-al Analog Scale-VAS) and the Oswestry scale (Oswestry Disability Index-ODI) were examined. Wilcoxon Signed Ranks test was used for statistical study. The statistical significance level was determined as p<0.05.
Results: The differences between the postoperative cobb angle, coronal balance, VAS and ODI values and preoperative values in the patient groups using single and double rods were statically significant (p<0.05). Changes in PI, PT, SS and SVA values of spinopelvic parameters within each group were not statistically significant (p>0.05). There was no statistically significant change in the parameters between the two groups (p>0.05).
Conclusion: One of the most important criteria for correcting coronal mismatch is the selection of appropriate levels for instrumentation and adequate correction. In our study, it was observed that clinical improvement was not related to the number of rods, but to how successfully the coronal imbalance was corrected. In addition, it should be kept in mind that the load on the rods may cause implant failure in long-term follow-ups. The use of double rods should be kept in mind as a solution to this problem.
References
- Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus. 2010;28:E1–E10.
- Kotwal S, Pumberger M, Hughes A, Girardi F. Degenerative scoliosis: a review. HSS J 2011;7:257–264.
- Pumberger M, Schmidt H, Putzier M. Spinal Deformity Surgery: A Critical Review of Alignment and Balance. Asian Spine J. 2018;12(4):775-783. doi: 10.31616/asj.2018.12.4.775.
- Thambiraj S, Boszczyk BM. Asymmetric osteotomy of the spine for coronal imbalance: a technical report. Eur Spine J 21(Suppl 2). 2012:S225–S229. doi:10.1007/s00586-012-2171-9.
- Lamartina C, Berjano P, Petruzzi M, et al. Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J 21(Suppl 1). 2012:S27–S31.
- Barile F, Ruffilli A, Paolucci A, et al. Risk factors for postoperative coronal imbalance after surgical correction of adult spinal deformities: a systematic review with pooled analysis. J Neurosurg Spine. 2023;38(5):558-572. doi: 10.3171/2023.1.SPINE22669.
- Obeid I, Berjano P, Lamartina C, Chopin D, Boissière L, Bourghli A. Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline. Eur Spine J. 2019;28(1):94-113. doi: 10.1007/s00586-018-5826-3.
- Cho W, Mason JR, Smith JS, et al. Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors: clinical article. J Neurosurg Spine. 2013;19:445–453. doi: 10.3171/2013.6.SPINE121129.
- Simon J, Longis PM, Passuti N. Correlation between radiographic parameters and functional scores in degenerative lumbar and thoracolumbar scoliosis. Orthop Traumatol Surg Res. 2017;103(2):285-290. doi: 10.1016/j.otsr.2016.10.021.
- Takemoto M, Boissière L, Vital JM, et al. Are sagittal spinopelvic radiographic parameters significantly associated with quality of life of adult spinal deformity patients? Multivariate linear regression analyses for pre-operative and short-term post-operative health-related quality of life. Eur Spine J. 2016;26:2176–2186.
- Bao H, Zhu F, Liu Z, et al. Coronal curvature and spinal imbalance in degenerative lumbar scoliosis: disc degeneration is associated. Spine (Phila Pa 1976). 2014;39(24):E1441-7. doi: 10.1097/BRS.0000000000000603.
- Jimbo S, Kobayashi T, Aono K, et al. Epidemiology of degenerative lumbar scoliosis: a community based cohort study. Spine (Phila Pa 1976). 2012;37:1763-70 .
- Koller H, Pfanz C, Meier O, et al. Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients. Eur Spine J. 2016;25(2):532-48. doi: 10.1007/s00586-015-3898-x.
- Ploumis A, Simpson AK, Cha TD, Herzog JP, Wood KB. Coronal spinal balance in adult spine deformity patients with long spinal fusions: a minimum 2-5 year follow-up study. J Spinal Disord Tech. 2013;28:341–347.
- Theologis AA, Safaee M, Scheer JK, et al. International Spine Study Group (ISSG). Magnitude, location, and factors related to regional and global sagittal alignment change in long adult deformity constructs: report of 183 patients with 2-year follow-up. Clin Spine Surg. 2017;30(7):E948-E953. doi: 10.1097/BSD.0000000000000503.
- Daubs MD, Lenke LG, Bridwell KH, et al. Does correction of preoperative coronal imbalance make a difference in outcomes of adult patients with deformity? Spine (Phila Pa 1976) 2013;38:476–483.
- Sun Z, Qiu G, Zhao Y, Wang Y, Zhang J, Shen J. Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar/lumbar idiopathic scoliosis: lower-end vertebra or lower-end vertebra1? Eur Spine J. 2014;23(6):1251–1257. doi: 10.1007/s00586-014-3276-0.
- Cecchinato R, Berjano P, Aguirre MFI, Lamartina C. Asymmetrical pedicle subtraction osteotomy in the lumbar spine in combined coronal and sagittal imbalance. Eur Spine J. 2015;24(suppl 1):S66–S71.
- Lewis SJ, Keshen SG, Kato S, Dear TE, Gazendam AM. Risk factors for postoperative coronal balance in adult spinal deformity surgery. Global Spine J. 2018;8(7):690–697. doi: 10.1177/2192568218764904.
Lomber Dejeneratif Skolyozlardaki Koronal Dengesizlikte Çift Rod Kullanımının Düzeltme Üzerindeki Etkisi
Abstract
Giriş: Lomber dejeneratif skolyozda uygulanan cerrahilerde hedef; koronal ve sagittal dengenin sağlanmasıdır. Uygun hizalanma ile oluşan denge hastanın postoperatif yaşam kalitesi ve memnuniyeti ile yakından ilişkilidir. Sagittal ve koronal denge için her iki düzlemde cerrahi manevralara ihtiyaç duyulur. Bu çalışmadaki amacımız, koronal dengesizlikte tek ya da çift rod kullanımının koronal uyumsuzluğun düzeltilmesi üzerindeki etkisini değerlendirmektir.
Yöntem: Çalışmaya Ocak 2019-Aralık 2021 tarihleri arasında kurumumuza başvuran lomber dejeneratif skolyoz tanısı almış toplam 22 hasta (14 kadın ve 8 erkek, ortalama yaş 64,3±10,3 yıl) dahil edildi. Hastalar iki gruba ayrıldı, birinci grup tekli rod (n:11), ikinci grup çiftli rod (n:11) uygulanan hastalar olarak belirlendi. Hastaların cerrahi öncesi ve sonrası 12. ayda skolyoz grafisi üzerinden pelvik insidans (PI), sakral slope (SS), pelvik tilt (PT), lomber lordoz (LL), sagittal vertikal aks (SVA), cobb açısı, santral sakral vertikal line (CSVL), T1 plumbline dahil olmak üzere her hastanın spinopelvik parametre ölçümleri yapıldı. Ayrica Vizuel Analog Skala (Visual Analog Scale-VAS) ve Oswestry skalası (Oswestry Disability Index-ODI)’na bakıldı. İstatistiksel çalışma için Wilcoxon Signed Ranks testi kullanıldı. İstatistiksel anlamlılık düzeyi p <0,05 olarak belirlendi.
Bulgular: Tek ve çift rod kullanılan hasta gruplarındaki postoperatif cobb açısı, koronal balans, VAS ve ODI değerleri ile preoperatif değerler arasındaki farklılıklar istatistiksel olarak (p<0,05) anlamlıydı. Her bir grup içindeki spinopelvik parametrelerden PI, PT, SS ve SVA değerlerindeki değişiklikler istatistiksel olarak (p>0,05) anlamlı değildi. Her iki grup arasındaki parametrelerde istatistiksel anlamlı bir değişim saptanmadı (p>0,05).
Sonuç: Koronal uyumsuzluğun düzeltilmesi için en önemli kriterlerden biri enstrümantasyon için uygun seviyelerin seçilmesi ve yeterli düzeltme yapılmasıdır. Yaptığımız çalışmada klinik iyileşmenin rod sayısı ile ilişkili olmadığı, koronal dengesizliğin ne kadar başarılı şekilde düzeltildiği ile bağlantılı olduğu gözlenmiştir. Bunun yanında uzun süreli takiplerde rodlara binecek yükün implant yetmezliğine neden olabileceği unutulmamalıdır. Bu soruna çözüm olarak çiftli rod kullanılması akılda tutulmalıdır.
References
- Silva FE, Lenke LG. Adult degenerative scoliosis: evaluation and management. Neurosurg Focus. 2010;28:E1–E10.
- Kotwal S, Pumberger M, Hughes A, Girardi F. Degenerative scoliosis: a review. HSS J 2011;7:257–264.
- Pumberger M, Schmidt H, Putzier M. Spinal Deformity Surgery: A Critical Review of Alignment and Balance. Asian Spine J. 2018;12(4):775-783. doi: 10.31616/asj.2018.12.4.775.
- Thambiraj S, Boszczyk BM. Asymmetric osteotomy of the spine for coronal imbalance: a technical report. Eur Spine J 21(Suppl 2). 2012:S225–S229. doi:10.1007/s00586-012-2171-9.
- Lamartina C, Berjano P, Petruzzi M, et al. Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J 21(Suppl 1). 2012:S27–S31.
- Barile F, Ruffilli A, Paolucci A, et al. Risk factors for postoperative coronal imbalance after surgical correction of adult spinal deformities: a systematic review with pooled analysis. J Neurosurg Spine. 2023;38(5):558-572. doi: 10.3171/2023.1.SPINE22669.
- Obeid I, Berjano P, Lamartina C, Chopin D, Boissière L, Bourghli A. Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline. Eur Spine J. 2019;28(1):94-113. doi: 10.1007/s00586-018-5826-3.
- Cho W, Mason JR, Smith JS, et al. Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors: clinical article. J Neurosurg Spine. 2013;19:445–453. doi: 10.3171/2013.6.SPINE121129.
- Simon J, Longis PM, Passuti N. Correlation between radiographic parameters and functional scores in degenerative lumbar and thoracolumbar scoliosis. Orthop Traumatol Surg Res. 2017;103(2):285-290. doi: 10.1016/j.otsr.2016.10.021.
- Takemoto M, Boissière L, Vital JM, et al. Are sagittal spinopelvic radiographic parameters significantly associated with quality of life of adult spinal deformity patients? Multivariate linear regression analyses for pre-operative and short-term post-operative health-related quality of life. Eur Spine J. 2016;26:2176–2186.
- Bao H, Zhu F, Liu Z, et al. Coronal curvature and spinal imbalance in degenerative lumbar scoliosis: disc degeneration is associated. Spine (Phila Pa 1976). 2014;39(24):E1441-7. doi: 10.1097/BRS.0000000000000603.
- Jimbo S, Kobayashi T, Aono K, et al. Epidemiology of degenerative lumbar scoliosis: a community based cohort study. Spine (Phila Pa 1976). 2012;37:1763-70 .
- Koller H, Pfanz C, Meier O, et al. Factors influencing radiographic and clinical outcomes in adult scoliosis surgery: a study of 448 European patients. Eur Spine J. 2016;25(2):532-48. doi: 10.1007/s00586-015-3898-x.
- Ploumis A, Simpson AK, Cha TD, Herzog JP, Wood KB. Coronal spinal balance in adult spine deformity patients with long spinal fusions: a minimum 2-5 year follow-up study. J Spinal Disord Tech. 2013;28:341–347.
- Theologis AA, Safaee M, Scheer JK, et al. International Spine Study Group (ISSG). Magnitude, location, and factors related to regional and global sagittal alignment change in long adult deformity constructs: report of 183 patients with 2-year follow-up. Clin Spine Surg. 2017;30(7):E948-E953. doi: 10.1097/BSD.0000000000000503.
- Daubs MD, Lenke LG, Bridwell KH, et al. Does correction of preoperative coronal imbalance make a difference in outcomes of adult patients with deformity? Spine (Phila Pa 1976) 2013;38:476–483.
- Sun Z, Qiu G, Zhao Y, Wang Y, Zhang J, Shen J. Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar/lumbar idiopathic scoliosis: lower-end vertebra or lower-end vertebra1? Eur Spine J. 2014;23(6):1251–1257. doi: 10.1007/s00586-014-3276-0.
- Cecchinato R, Berjano P, Aguirre MFI, Lamartina C. Asymmetrical pedicle subtraction osteotomy in the lumbar spine in combined coronal and sagittal imbalance. Eur Spine J. 2015;24(suppl 1):S66–S71.
- Lewis SJ, Keshen SG, Kato S, Dear TE, Gazendam AM. Risk factors for postoperative coronal balance in adult spinal deformity surgery. Global Spine J. 2018;8(7):690–697. doi: 10.1177/2192568218764904.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Articles |
| Authors | |
| Early Pub Date | August 31, 2023 |
| Publication Date | September 9, 2023 |
| Acceptance Date | July 10, 2023 |
| Published in Issue | Year 2023 Issue: 20 |
Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)