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Differences in lumbar segment angle among Roussouly types of global sagittal alignment in asymptomatic adult subjects

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Abstract

Study design

A radiological study.

Objectives

To examine lumbar segment angle according to the Roussouly type of global sagittal alignment and to determine the reference disc angles in minimally invasive surgery (MIS) for adult spinal deformity.

Summary of background data

Optimal restoration of lumbar lordosis (LL) in adult spinal deformity surgery includes achieving the ideal shape of LL as well as the amount of LL. However, the distribution of lumbar segment angles by the Roussouly type has yet to be elucidated.

Methods

Forty sets of whole spine lateral radiographs covering the four Roussouly types (N = 160) were obtained from a database of asymptomatic adult subjects. Global and spinopelvic parameters were measured. Disc and vertebral angles at each lumbar level were compared among the Roussouly types.

Results

There were 75 (46.9%) men with a mean age of 32.8 ± 8.9 years among the total of 160 study subjects. A significant difference was found in spino-sacral angle, sacral slope, pelvic incidence, LL, and lower arc of LL (L4S1) among the Roussouly types (all P < 0.001). The ratio of the lower arc of LL (L4S1) to LL was 83.4% in Roussouly type 1, 65.2% in type 2, 64.7% in type 3, and 61.5% in type 4. The disc angles at the L1-2 and L2-3 levels in Roussouly type 1 were significantly smaller than in the other types. The disc angle at the L5-S1 level in Roussouly type 1 was significantly larger than that in type 2. Roussouly type 4 had a larger disc angle at the L2-3 and L4-5 levels than types 1 and 2.

Conclusions

The results of this study showed that the disc angle distribution differs among Roussouly types. The configuration of LL as well as the amount of LL should be considered in adult spinal deformity surgery.

Level of evidence

Level IV.

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References

  1. Le Huec JC, Saddiki R, Franke J, Rigal J, Aunoble S (2011) Equilibrium of the human body and the gravity line: the basics. Eur Spine J 20(Suppl 5):558–563

    Article  Google Scholar 

  2. Amabile C, Le Huec JC, Skalli W (2018) Invariance of head-pelvis alignment and compensatory mechanisms for asymptomatic adults older than 49 years. Eur Spine J 27(2):458–466

    Article  Google Scholar 

  3. Stagnara P, De Mauroy JC, Dran G et al (1982) Reciprocal angulation of vertebral bodies in a sagittal plane: approach to references for the evaluation of kyphosis and lordosis. Spine (Phila Pa 1976) 7(4):335–342

    Article  CAS  Google Scholar 

  4. Bernhardt M, Bridwell KH (1989) Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine (Phila Pa 1976) 14(7):717–721

    Article  CAS  Google Scholar 

  5. Gelb DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine (Phila Pa 1976) 20(12):1351–1358

    Article  CAS  Google Scholar 

  6. Jackson RP, Kanemura T, Kawakami N, Hales C (2000) Lumbopelvic lordosis and pelvic balance on repeated standing lateral radiographs of adult volunteers and untreated patients with constant low back pain. Spine (Phila Pa 1976) 25(5):575–586

    Article  CAS  Google Scholar 

  7. Vialle R, Levassor N, Rillardon L, Templier A, Skalli W, Guigui P (2005) Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Jt Surg Am 87(2):260–267

    Article  Google Scholar 

  8. Boulay C, Tardieu C, Hecquet J et al (2006) Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 15(4):415–422

    Article  CAS  Google Scholar 

  9. Schwab F, Lafage V, Patel A, Farcy JP (2009) Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976) 34(17):1828–1833

    Article  Google Scholar 

  10. Lee CS, Chung SS, Park SJ, Kim DM, Shin SK (2014) Simple prediction method of lumbar lordosis for planning of lumbar corrective surgery: radiological analysis in a Korean population. Eur Spine J 23(1):192–197

    Article  Google Scholar 

  11. Lafage R, Schwab F, Challier V et al (2016) Defining spino-pelvic alignment thresholds: should operative goals in adult spinal deformity surgery account for age? Spine (Phila Pa 1976) 41(1):62–68

    Article  Google Scholar 

  12. Le Huec JC, Hasegawa K (2016) Normative values for the spine shape parameters using 3D standing analysis from a database of 268 asymptomatic Caucasian and Japanese subjects. Eur Spine J 25(11):3630–3637

    Article  Google Scholar 

  13. Roussouly P, Gollogly S, Berthonnaud E, Dimnet J (2005) Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 30(3):346–353

    Article  Google Scholar 

  14. Berjano P (2018) Reviewer’s comment concerning “Classification of normal sagittal spine alignment: refounding the Roussouly classification” by F. Laouissat et al. (2017). https://doi.org/10.1007/s00586-017-5111-x Eur Spine J 7(8):2012–3. (Epub ahead of print)

    Article  Google Scholar 

  15. Barrey C, Jund J, Noseda O, Roussouly P (2007) Sagittal balance of the pelvis–spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur Spine J 16(9):1459–1467

    Article  Google Scholar 

  16. Sebaaly A, Grobost P, Mallam L, Roussouly P (2018) Description of the sagittal alignment of the degenerative human spine. Eur Spine J 27(2):489–496

    Article  Google Scholar 

  17. Sebaaly A, Riouallon G, Obeid I et al (2018) Proximal junctional kyphosis in adult scoliosis: comparison of four radiological predictor models. Eur Spine J 27(3):613–621

    Article  Google Scholar 

  18. Lee CS, Park SJ, Chung SS, Lee JY, Yum TH, Shin SK (2016) Mini-open anterior lumbar interbody fusion combined with lateral lumbar interbody fusion in corrective surgery for adult spinal deformity. Asian Spine J 10(6):1023–1032

    Article  Google Scholar 

  19. Mundis GM Jr, Turner JD, Kabirian N et al (2017) Anterior column realignment has similar results to pedicle subtraction osteotomy in treating adults with sagittal plane deformity. World Neurosurg 105:249–256

    Article  Google Scholar 

  20. Kanter AS, Tempel ZJ, Ozpinar A, Okonkwo DO (2016) A review of minimally invasive procedures for the treatment of adult spinal deformity. Spine (Phila Pa 1976) 41(Suppl 8):S59–S65

    Google Scholar 

  21. Akbarnia BA, Mundis GM Jr, Moazzaz P et al (2014) Anterior column realignment (ACR) for focal kyphotic spinal deformity using a lateral transpsoas approach and ALL release. J Spinal Disord Tech 27(1):29–39

    Article  Google Scholar 

  22. Hu P, Yu M, Sun Z et al (2016) Analysis of global sagittal postural patterns in asymptomatic Chinese adults. Asian Spine J 10(2):282–288

    Article  Google Scholar 

  23. Cho Y (2017) Evaluation of global sagittal balance in koreans adults. J Korean Neurosurg Soc 60(5):560–566

    Article  Google Scholar 

  24. Yu M, Zhao WK, Li M et al (2015) Analysis of cervical and global spine alignment under Roussouly sagittal classification in Chinese cervical spondylotic patients and asymptomatic subjects. Eur Spine J 24(6):1265–1273

    Article  Google Scholar 

  25. Berjano P, Cecchinato R, Sinigaglia A et al (2015) Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study. Eur Spine J 24(Suppl 3):433–438

    Article  Google Scholar 

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Funding

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Geyounggi-do, 16499, South Korea

    Nam-Su Chung, Han-Dong Lee & Chang-Hoon Jeon

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  1. Nam-Su Chung
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  2. Han-Dong Lee
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  3. Chang-Hoon Jeon
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Contributions

The roles of authors: NSC: conception or design of the work; the acquisition, analysis, interpretation of data for the work, drafting the work or revising it critically for important intellectual content, final approval of the version to be published. HDL: the acquisition, analysis, interpretation of data for the work, drafting the work or revising it critically for important intellectual content, final approval of the version to be published. CHJ: conception or design of the work, drafting the work or revising it critically for important intellectual content, final approval of the version to be published

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Correspondence to Chang-Hoon Jeon.

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The authors declare that they have no conflict of interest.

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The ethical committee of the hospital reviewed and approved the design of the present study.

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Chung, NS., Lee, HD. & Jeon, CH. Differences in lumbar segment angle among Roussouly types of global sagittal alignment in asymptomatic adult subjects. Spine Deform 8, 227–232 (2020). https://doi.org/10.1007/s43390-019-00010-6

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