Document Detail


Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms.
MedLine Citation:
PMID:  24682355     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
INTRODUCTION: Sagittal balance is an independent predictor of clinical outcomes in spinal care. Surgical treatment is challenging and jeopardized by frequent complications. Guidelines for surgical treatment are currently not based on a classification of the disease. A comprehensive classification of sagittal balance based on regional deformities and compensatory mechanisms combined in deformity patterns is proposed. Though the sagittal shape of the spine can change due to degeneration or trauma, correlations between sagittal shape parameters and pelvic incidence (PI) have been described. Pelvic incidence is not changed by degeneration, thus representing a permanent source of information on the original sagittal shape of the spine.
METHODS: One hundred and twenty-eight full-spine lateral standing radiographs of patients with different spinal conditions were evaluated and classified by one rater. One random subseries of 35 patients was evaluated by two raters for calculation of inter-rater agreement. Spinopelvic parameters were measured in all the radiographs. Internal validity of the classification system was evaluated comparing the values of regional sagittal parameters that distinguish one category from the others.
RESULTS: Eight different patterns were identified regarding the site of the deformity and the presence of compensatory mechanisms: cervical, thoracic, thoracolumbar junction, lumbar, lower lumbar, global and pelvic kyphosis and normal sagittal alignment. Inter-rater agreement was almost perfect (κ = 0.963). Statistically significant differences were found comparing the means of selected sagittal spinopelvic parameters that conceptually divide pairs or groups of categories: C2-C7 SVA for cervical kyphosis vs all other patients, TK-PI mismatch for thoracic kyphosis vs all other patients, T11-L2 kyphosis for thoracolumbar kyphosis vs all other patients, global alignment (LL+TK-PI) and SVA for lumbar kyphosis vs global kyphosis and pelvic tilt for pelvic kyphosis vs lumbar, lower lumbar and global kyphosis.
CONCLUSION: A comprehensive classification of sagittal imbalance is presented. This classification permits a better interpretation of the deformity and muscle forces acting on the spine, and helps surgical planning. Preliminary validation has been provided.
Authors:
Claudio Lamartina; Pedro Berjano
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-2-28
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  -     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2014 Feb 
Date Detail:
Created Date:  2014-3-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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