Sagittal balance in thoracolumbar or lumbar

congenital kyphoscoliosis and kyphosisat a minimum of 10 years after surgery

: A case series

Miyazaki S, Suzuki T, Inui Y, Kawakita K

Dogaki Y, Kurakawa T, Uno K

9th ICEOS Annual Meeting, Boston, November 19-20 in 2015

Department of Orthpaedic Surgery National Hospital Organization Kobe Medical Center

DisclosureDisclosureAuthor　

Relationships Disclosed

Miyazaki SSuzuki TInui YKawakita KDogaki YKurakawa TUno K 　

No RelationshipNo RelationshipNo RelationshipNo RelationshipNo RelationshipNo RelationshipNo Relationship

Postoperative sagittal balance in congenital kyphoscoliosis and kyphosis remain unclear.

The restoration of proper sagittal alignment is crucial for obtaining satisfactory clinical outcome in adult spinal deformity.

BackgroundBackground

Glassman SD, et al. SPINE 2005

ObjectiveObjective

To elucidate sagittal balance inthoracolumbar or lumbar congenital kyphoscoliosis and kyphosis

at a minimum of 10 years follow-upafter surgery

To elucidate sagittal balance inthoracolumbar or lumbar congenital kyphoscoliosis and kyphosis

at a minimum of 10 years follow-upafter surgery

MaterialsMaterials16 cases A retrospective analysis of the patients with

congenital kyphoscoliosis and kyphosis

Age (y.o.) : 　Gender (boy ：girl) : 　

6 ：10 　

10.1 ± 3.6 　

Vertebral anomalies

At initial surgery

Duration of follow-up (years) : 16.3 ± 4.0

Solitary simple Multiple simpleComplex

6 cases

　7 cases3 cases

Kawakami N, et al. SPINE 2009

Posterior only

13 cases

Anterior + Posterior

3 cases

Surgical proceduresSurgical procedures16 cases

Additional Surgery 8 cases

✓Pseudoarthrosis✓Adjacent segmental disease✓Coronal decompensation✓Sagittal decompensation

1 case 　

1 case 　1 case 　

✓Implant failure

2 cases 　3 cases 　

Number of fused segment: 1.3 above and 1.3 below

Extension of fused segment

Radiological evaluationsRadiological evaluations

C7 Plumb line

C7 Plumb line

CSVL

Coronal plane

Sagittal plane

✓ Cobb angle of main curve

✓ Coronal balance

✓ Segmental angle of kyphosis

✓ Lumbar lordosis (LL)the angle between the lower endplate of LIV and the upper endplate of S1

✓ Sagittal vertical axis (SVA)

✓ Pelvic incidence (PI)

✓ Pelvic tilt (PT)

✓ Sacral slope (SS)

Results (Overall)Results (Overall)Pre OP Post OP Latest

Main curve 55.1±16.7 32.8±17.1 34.8±13.4

Coronal balance -9.8±17.1 3.3±18.6 4.2±8.8

Kyphosis 33.9±20.1 15.7±18.3 16.4±21.8

LL 44.5±28.0 37.1±22.4 34.7±19.1

SVA 13.1±33.8 18.4±22.2 33.8±57.1

PT 17.3±14.0 18.5±10.1 22.9±13.9

SS 28.5±9.2 28.1±7.3 23.7±11.7

✓Proximal junctional kyphosis (PJK)

✓Progression of the kyphosis

Cases of sagittal imbalanceCases of sagittal imbalanceshowed more than 40 mm of SVA at latest follow-up and more than 30 mm positive shift of SVA during follow-up period.

Pre OP Post OP Latest

Kyphosis 50.8±15.5 30.4±14.1 25.6±19.7

LL 41.8±45.3 32.4±39.5 17.0±17.6

PT 25.2±8.6 25.8±5.4 37.4±7.4

p<0.05＊

＊

＊

＊

＊

＊

1 case 　2 cases 　

5 cases

Post 2nd OP 15 years

Post 2nd OP 7 years

Post 2nd OP

34°

C7 Plumb line

+38 mm +27

16°

+105

21°

17°

+30

28°

17°

78°

65°

Th12

L1

Illustrative case reportPre OP

(4 years old)

28° 45°35°24°

Kyphosis

LL

PT

SVA

DiscussionDiscussion

PJK

LL　

PT　

Pre OP Post OP

Mobile segment 　

Compensation Decompensation

Degeneration

✓ The development of secondary changes could be avoided only by early and complete correction of the local deformity.

Ruf M, Harms J. SPINE 2009 Our study

Sagittal imbalance

Considering re-operation with extension of fused segment

Residual kyphosis

Kyphosis Rigid & structural 　

ConclusionConclusion

Postoperative sagittal balance in thoracolumbar or lumbarcongenital kyphoscoliosis and kyphosis could deteriorate due to residual kyphosis and decompensation in the sagittal plane despite the early correction and short fusion.