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Sagittal Decompensation Following Corrective Osteotomy for Lumbar Degenerative Kyphosis; Classification and Risk Factors.
MedLine Citation:
PMID:  21240054     Owner:  NLM     Status:  Publisher    
ABSTRACT: Study design. A retrospective studyObjectives To classify the types and identify related factors on sagittal decompensation following corrective osteotomy for lumbar degenerative kyphosis (LDK).Introduction There has been a skeptical view of surgical treatment of LDK owing to loss of sagittal balance even after correction of kyphosis. However, there had been no report on the classification and risk factors of sagittal decompensation.Methods. A total of 23 LDK patients underwent corrective osteotomy were enrolled. The mean follow-up period was 45.7 months. Radiographic parameters including sagittal balance, the cross sectional area of paravertebral muscles were analyzed. We classified the type of sagittal decompensation into thoracic (Group T) and lumbar decompensation (Group L) with a reference line from the posterosuperior corner of the sacrum to the center of the T12-L1 disc. The type of sagittal decompensation was defined with the location of T1 and the reference line at the last follow up radiographs.Results. The mean number of fusion segments was 7.7. Sagittal balance improved from 26.4cm to 4cm immediately after operation but deteriorated to 11.2cm at the last follow up. The decompensation was greater in group T (11 cases) than L (12 cases) (9.1:5.2cm, p = 0.03). The comparative analysis showed significant differences between group T and L in thoracic kyphosis at the last follow up (group T:L = 40.5: 27.5° p = 0.04), preoperative thoracic kyphotic angle (group T:L = 19.6: -1°, p = 0.01), mean ratio of cross sectional area of paravertebral muscles to interveryebral disc in T12-L1, and incidence of the preoperative compensatory thoracic lordosis (group T:L = 27.3:100%, p = 0).Conclusions. The mean sagittal decompensation following corrective osteotomy for LDK was 38.3%. The etiology was loss of lumbosacral lordosis in Group L and progression of kyphosis at the proximal unfused segments in addition to lumbosacral loss in Group T. The decompensation was greater in the thoracic type than in the lumbar type and was considered relevant to a large preoperative thoracic kyphotic angle, absence of compensatory thoracic lordosis, and atrophy of paravertebral muscles.
Sang-Hun Lee; Ki-Tack Kim; Kyung-Soo Suk; Jung-Hee Lee; Eun-Min Seo; Dae-Seok Huh
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-13
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Department of Orthopedic Surgery, Spine center, East-west Neomedical center Kyung Hee University, Seoul, Korea 2Chuncheon sacred heart hospital, Hallym University, Chuncheon, Korea.
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