J Korean Soc Spine Surg.  2002 Jun;9(2):133-142.

The Relationship between Sagittal Spinal Alignment and Surgical Results in Degenerative Lumbar Scoliosis with Spinal Stenosis

• Kim WJ
• Yeom JS
• Kang JW
• Kim KH
• Lee SH
• Choy KJ
• Choy WS

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To analyze the correlation between clinical results and sagittal vertical axis, clinical results and total lumbar lordosis in degenerative lumbar scoliosis with spinal stenosis. SUMMARY OF LITERATURE REVIEW: There has been no report about the relation between sagittal spinal alignment and surgical outcome of degenerative lumbar scoliosis.
MATERIALS AND METHODS
We reviewed 38 surgical cases of degenerative lumbar scoliosis from February 1997 to February 2001 with an average follow-up of 35 months. In whole spine standing AP and lateral radiographs, scoliotic angle(Cobb method), total lumbar lordosis(L1-S1) and the sagittal vertical axis(C7 plumb line) were measured. In lumbar flexion-extension and standing side bending views, the lateral translation was measured and instability was determined. Clinical results were evaluated based on the Kirkaldy-Willis criteria.
RESULTS
The scoliotic angles at preoperative, postoperative and follow-up were 15.0+/-4.9, 5.3+/-3.1 and 7.1+/-3.7 degrees retro-spectively. Total lumbar lordosis were 28.7+/-6.1, 40.6+/-7.3 and 35.1+/-10.2 degrees retrospectively. Sagittal vertical axis at preoperative and the last follow-up were 3.3+/-3.2 and 0.1 +/-3.3 cm retrospectively. According to Kirkaldy-Willis criteria, 6 cases were excellent, 24 cases good, 7 cases fair and 1 case poor. There was no statistical correlation between total lumbar lordosis and the clinical results (r=-0.061, p=0.717). Sagittal vertical axis was significantly correlated with the clinical results (r=0.519, p=0.001).
CONCLUSIONS
For improvement of surgical outcome of degenerative lumbar scoliosis, the sagittal vertical axis should be used as a parameter of sagittal alignment rather than the total lumbar lordosis.

Keyword

Lumbar spine; Degenerative scoliosis; Sagittal spinal alignment; Sagittal vertical axis

MeSH Terms

Animals
Axis, Cervical Vertebra
Follow-Up Studies
Lordosis
Retrospective Studies
Scoliosis*
Spinal Stenosis*
Spine

Figure

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  Fig. 1. Method of measurement of various parameters of sagittal spinal alignment. Sagittal vertical axis is the horizontal distance from the C7 plumb line to the anterior superior corner of the sacrum. Positive value indicated a line passing anterior to the front of the sacrum, a neutral value indicated a line passing through of the sacrum and a negative value indicated a line passing behind of the sacrum. The angle A is the total lumbar lordosis measured between a line drawn across the top of the L1 and a similar line drawn across the top of the S1.

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  Fig. 2-A. Preoperative radiographs of a 57-year-old woman with degenerative lumbar kyphoscoliosis show sagittal imbalance of spine (scoliotic angle: 18°, total lumbar lordosis: -10°, sagittal vertical axis: 4 cm). Fig. 2-B. Followup 12 months radiographs after decompression and PLF & PLIF with instrumentation show sagittal balance of spine (scoliotic angle: 7°, total lumbar lordosis: 15°, sagittal vertical axis: 0 cm).

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  Fig. 3-A. Preoperative radiographs of a 59-year-old woman with degenerative lumbar scoliosis show 15° scoliotic angle, 20° total lumbar lordosis and 0 cm sagittal vertical axis. Fig. 3-B. Followup 14 months radiographs after decompression and PLF with instrumentation show sagittal balance of spine (scoliotic angle: 4°, total lumbarlordosis: 25°, sagittal vertical axis: 0 cm).

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  Fig. 4-A. Preoperative radiographs of a 65-year-old male with degenerative lumbar scoliosis show sagittal imbalance of spine (scoliotic angle: 30°, total lumbar lordosis: 30°, sagittal vertical axis: 4 cm). Fig. 4-B. Followup 12 months radiographs after decompression and PLF with instrumentation show sagittal imbalance of spine (scoliotic angle: 8°, total lumbar lordosis: 40°, sagittal vertical axis: 3 cm).

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