Upper versus Lower Lumbar Lordosis Corrections in Relation to Pelvic Tilt - An Essential Element in Surgical Planning for Sagittal Plane Deformity.
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2022-08
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Abstract
Study design
Retrospective study of a multicenter Adult Spinal Deformity (ASD) Database.Objective
To investigate the change in Pelvic tilt (PT) imparted by regional changes in lumbar lordosis at 2-year minimum follow up.Summary of background data
The distribution of lumbar lordosis between L1-4 and L4-S1 is known to vary based on pelvic incidence (PI). However, the extent to which regional changes effect PT is not clearly elucidated. This information can be useful for ASD surgical planning.Methods
Operative patients from a multicenter ASD database were included with Lowest Instrumented Vertebrae (LIV) S1/Ilium, >5 levels of fusion, Proximal Junction Kyphosis (PJK) angle < 20, and >5 degrees of change in lumbar lordosis from L4-S1 and L1-4. Radiographic analysis was performed evaluating Thoracic Kyphosis (TK), T10-L2 kyphosis (TL), L1-S1 lordosis (LL), L4-S1 lordosis, L1-4 lordosis, sagittal vertical axis (SVA) and PI-LL from preoperative to postoperative, and change at 2-years follow-up. Stepwise regression analysis was performed in order to determine the relationship between PT and the above radiographic parameters. Health-related quality of life (HRQOL) outcomes were also compared between preoperative and postoperative timepoints at 2 years.Results
103 patients met inclusion for the study. There was improvement in all the radiographic parameters and HRQOLs at 2 years follow-up (p < 0.01). Stepwise regression model showed an inverse relationship between PT and LL change (r = 0.71, p < 0.01). Regionally, an increase in 10 degrees from L4-S1 correlated with a 2.4 degree decrease in PT (p < 0.01), while an increase in 10 degrees from L1-4 resulted in a 1.6 degree decrease in PT (p < 0.01).Conclusion
In the surgical planning for ASD, our data demonstrated significant correlational difference between corrections in the upper (L1-4) and lower (L4-S1) lumbar spine and PT changes. These calculations can be useful in planning sagittal plane corrections for ASD.Type
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Kim, Han Jo, R Kiran Alluri, Renaud Lafage, Jonathan Elysee, Justin S Smith, Gregory M Mundis, Christopher I Shaffrey, Christopher P Ames, et al. (2022). Upper versus Lower Lumbar Lordosis Corrections in Relation to Pelvic Tilt - An Essential Element in Surgical Planning for Sagittal Plane Deformity. Spine, 47(16). pp. 1145–1150. 10.1097/brs.0000000000004370 Retrieved from https://hdl.handle.net/10161/28002.
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Christopher Ignatius Shaffrey
I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.
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