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

Whoan Jeang Kim; Jin Sup Yeom; Jong Won Kang; Kyou Hyeun Kim; Seung Hun Lee; Keun Jong Choy; Won Sik Choy

doi:10.4184/jkss.2002.9.2.133

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Kim, Yeom, Kang, Kim, Lee, Choy, and Choy: The Relationship between Sagittal Spinal Alignment and Surgical Results in Degenerative Lumbar Scoliosis with Spinal Stenosis

Original Article

Journal of Korean Spine Surg 2002;9(2):133-142.

Published online: 21 February 2002

DOI: https://doi.org/10.4184/jkss.2002.9.2.133

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

Whoan Jeang Kim, M.D., Jin Sup Yeom, M.D., Jong Won Kang, M.D.^∗, Kyou Hyeun Kim, M.D.^∗∗, Seung Hun Lee, M.D., Keun Jong Choy, M.D., Won Sik Choy, M.D.

Department of Orthopaedic Surgery, Eulji University, Taejon, Korea

^∗Cheongju St. Mary's Hospital, Chungju, Korea

^∗∗Kon-Kuk University Hospital, Chungju, Korea

Address reprint requests to Jin-Sup Yeom, M.D. Department of Orthopaedic Surgery, Eulji University 24-14, Mok-Dong, Chung-Ku, Taejon, 301-726, Korea Tel : 042-259-1286, Fax : 042-252-5498, E-mail : ortho@hananet.net

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 followup of 35 months. In whole spine standing A P 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 evaluat-ed based on the Kirkaldy-Willis criteria.

Results

The scoliotic angles at preoperative, postoperative and followup were 15.0± 4.9, 5.3± 3.1 and 7.1± 3.7 degrees retrospectively. 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 followup were 3.3± 3.2 and 0.1± 3.3 cm retrospectively. A ccording to Kirkaldy- W illis 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.

Keywords: Lumbar spine, Degenerative scoliosis, Sagittal spinal alignment, Sagittal vertical axis

REFERENCES

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Figures and Tables%

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.

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).

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).

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).

Table 1.

Radiological results

	Pre-op	Postop	F/U
Scoliotic angle (°)^∗	15.0± 4.9	5.3± 3.1	7.1± 3.7
Total lumbar lordosis (°)	28.7± 6.1	40.6± 7.3	35.1± 10.2
Sagittal vertical axis (cm)	3.3± 3.2	-	0.1± 3.3

^∗ Mean ± standard deviation

Table 2.

Correlation of total lumbar lordosis and sagittal vertical axis

Total lumbar lordosis (cases)	Sagittal vertical axis (cm)
< 30°(14)	+0.3± 2.8
31∼40°(17)	+0.5± 3.7
> 41°(7)	-1.0± 2.7

<p=0.68 (ANOVA test)

Table 3.

Kirkaldy-Willis criteria

	No. of cases (%)
Excellent	6 (15.7%)
Good	24 (63.2%)
Fair	7 (18.4%)
Poor	1 (2.6%)
Total	38 (100%)

Table 4.

Clinical results and total lumbar lordosis

Total lumbar lordosis	>= Good	=< Fair
< 30°	12	2
31∼40°	12	5
> 41°	6	1

p=0.579 (Fisher's exact test)

Table 5.

Clinical results and sagittal balance

Sagittal balance	>= Good	=< Fair
Balance^#	29	4
Imbalance	1	4

p=0.004 (Fisher's exact test)

^# Balance : C7 plumb line fall through the 1st sacral body

Table 6.

Correlation of clinical results

Factor	Correlation coefficient (r)	p value
Total lumbar lordosis	-0.061	0.717
Sagittal vertical axis	0.519	0.001

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