J Korean Neurosurg Soc.  2021 Nov;64(6):843-852. 10.3340/jkns.2020.0234.

Systematic Review of Reciprocal Changes after Spinal Reconstruction Surgery : Do Not Miss the Forest for the Trees

Affiliations
  • 1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

Abstract

The purpose of this review was to synthesize the research on global spinal alignment and reciprocal changes following cervical or thoracolumbar reconstruction surgery. We carried out a search of PubMed, EMBASE, and Cochrane Library for studies through May 2020, and ultimately included 11 articles. The optimal goal of a truly balanced spine is to maintain the head over the femoral heads. When spinal imbalance occurs, the human body reacts through various compensatory mechanisms to maintain the head over the pelvis and to retain a horizontal gaze. Historically, deformity correction has focused on correcting scoliosis and preventing scoliotic curve progression. Following substantial correction of a spinal deformity, reciprocal changes take place in the flexible segments proximal and distal to the area of correction. Restoration of lumbar lordosis following surgery to correct a thoracolumbar deformity induces reciprocal changes in T1 slope, cervical lordosis, pelvic shift, and lower extremity parameters. Patients with cervical kyphosis exhibit different patterns of reciprocal changes depending on whether they have head-balanced or trunk-balanced kyphosis. These reciprocal changes should be considered to in order to prevent secondary spine disorders. We emphasize the importance of evaluating the global spinal alignment to assess postoperative changes.

Keyword

Cervical vertebrae; Quality of life; Kyphosis; Systematic review

Figure

  • Fig. 1. Normative offset distance between bony landmarks and the gravity line [17]. Positive means anterior to the gravity line and negative means posterior to the gravity line. CAM : center of acoustic meatus, CI : confidence interval.

  • Fig. 2. Whole body image of thoracolumbar malalignment (left) exhibiting cervical hyperlordosis, posterior pelvic shift and knee flexion. Postoperative whole body image of the same patient (right) exhibiting restoration of lumbar lordosis (from 1.6° to 65.2°) with reciprocal changes in thoracic kyphosis (from -4.9° to 37.2°) cervical lordosis (from 23.1° to 9.5°), pelvic tilt (from 33.1° to 12.3°), knee flexion (from 9.5° to 3.6°) and ankle dorsiflexion (from 7.4° to 0.7°).

  • Fig. 3. Revised cervical spinal deformity classification system [18], which consists of a deformity descriptor and five modifiers. T : thoracic major, CBVA : chin-brow to vertical angle, TS : T1 slope, CL : cervical lordosis, mJOA : modified Japanese Orthopaedic Association, SRS : Scoliosis Research Society, L : lumbar major, D : double, N : no scoliosis, LL : lumbar lordosis.

  • Fig. 4. Compensation mechanisms in patients with symptomatic primary cervical kyphosis. PL : plumb line, CK : cervical kyphosis, LL : lumbar lordosis, PI : pelvic incidence, TK : thoracic kyphosis.

  • Fig. 5. Whole body images of a head-balanced (compensated) patient. While T1 slope, thoracic kyphosis, and lumbar lordosis changed, spinopelvic- and lower extremity parameters did not change following cervical kyphosis correction.

  • Fig. 6. Whole body images of a trunk-balanced (decompensated) patient. While T1 slope and thoracic kyphosis decreased, lumbar lordosis, spinopelvic- and lower extremity parameters did not change following cervical kyphosis correction.


Cited by  2 articles

Pediatric Spine Trauma
Sungjae An, Seung-Jae Hyun
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The Sagittal Balance of Cervical Spine : Comprehensive Review of Recent Update
Sang Hoon Lee, Tae Hwan Kim, Seok Woo Kim, Hyun Take Rim, Heui Seung Lee, Ji Hee Kim, In Bok Chang, Joon Ho Song, Yong Kil Hong, Jae Keun Oh
J Korean Neurosurg Soc. 2023;66(6):611-617.    doi: 10.3340/jkns.2023.0146.


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