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T12 Sagittal Tilt Predicts Thoracic Kyphosis

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Abstract

Study Design

Retrospective review and analysis of lateral long cassette radiographs.

Objective

The purpose of this paper is to assess whether certain radiographic features routinely seen on lumbar radiographs can predict a structural thoracic deformity.

Summary of Background Data

Obtaining proper sagittal alignment is an essential factor contributing to favorable clinical outcomes following spinal deformity surgery. The majority of patients treated with lumbar fusions do not undergo long cassette radiographs, and therefore physicians must rely upon clinical examination to determine the presence of a structural thoracic kyphotic deformity.

Methods

A total of 193 consecutive lateral long cassette radiographs of outpatients without prior spine surgery presenting to a spine surgeon were independently reviewed. Statistical analysis was performed on sagittal parameters that included the T12 slope, pelvic incidence, sacral slope, T2–T12 and T5–T12 kyphosis, and T12–S1 lordosis, and correlated with patient demographics.

Results

The age of the patient combined with the sagittal slope of T12 can be used to assess a patient’s risk of having a structural thoracic deformity defined in this series as >35 degrees from T5 to T12 and >40 degrees from T2 to T12. Based on our findings, for a given 20-year-old patient, the threshold T12 sagittal angle was about 17–18 degrees. This angle decreased 2–3 degrees per decade so that the threshold value was 12–13 degrees by age 40, 7–9 degrees by age 60, and 3–4 degrees by age 80.

Conclusion

Age and the sagittal slope of the 12th thoracic vertebra are effective predictors of kyphosis between T2–T12 and T5–T12. This information may be used to determine the need for long cassette radiographs to further examine the possible presence of kyphotic deformity in the thoracic spine.

Level of Evidence

Level IV.

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References

  1. Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 2005;30:2024–9.

    Article  Google Scholar 

  2. Kawakami M, Tamaki T, Ando M, et al. Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976) 2002;27:59–64.

    Article  Google Scholar 

  3. Videbaek TS, Bunger CE, Henriksen M, et al. Sagittal spinal balance after lumbar spinal fusion: the impact of anterior column support results from a randomized clinical trial with an eight- to thirteen-year radiographic follow-up. Spine (Phila Pa 1976) 2011;36:183–91.

    Google Scholar 

  4. Glassman SD, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 2005;30:682–8.

    Article  Google Scholar 

  5. Roussouly P, Nnadi C. Sagittal plane deformity: an overview of interpretation and management. Eur Spine J 2010;19:1824–36.

    Article  Google Scholar 

  6. D’Andrea LP, Betz RR, Lenke LG, et al. Do radiographic parameters correlate with clinical outcomes in adolescent idiopathic scoliosis? Spine (Phila Pa 1976) 2000;25:1795–802.

    Article  Google Scholar 

  7. Lamartina C, Berjano P, Petruzzi M, et al. Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis. Eur Spine J 2012;21(Suppl 1):S27–31.

    Article  Google Scholar 

  8. Kepler CK, Meredith DS, Green DW, et al. Long-term outcomes after posterior spine fusion for adolescent idiopathic scoliosis. Curr Opin Pediatr 2012;24:68–75.

    Article  Google Scholar 

  9. Kim MK, Lee SH, Kim ES, et al. The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: a pilot study. BMC Musculoskelet Disord 2011;12:69.

    Article  Google Scholar 

  10. Roussouly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976) 2005;30:346–53.

    Article  Google Scholar 

  11. Boulay C, Tardieu C, Hecquet J, et al. Sagittal alignment of spine and pelvis regulated by pelvic incidence: standard values and prediction of lordosis. Eur Spine J 2006;15:415–22.

    Article  CAS  Google Scholar 

  12. Rose PS, Bridwell KH, Lenke LG, et al. Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine (Phila Pa 1976) 2009;34:785–91.

    Article  Google Scholar 

  13. Kim HJ, Bridwell KH, Lenke LG, et al. Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections. Spine (Phila Pa 1976) 2014;39:E576–80.

    Article  Google Scholar 

  14. Cammarata M, Aubin CE, Wang X, et al. Biomechanical risk factors for proximal junctional kyphosis: a detailed numerical analysis of surgical instrumentation variables. Spine (Phila Pa 1976) 2014;39:E500–7.

    Article  Google Scholar 

  15. Kim HJ, Lenke LG, Shaffrey CI, et al. Proximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery: a systematic review. Spine (Phila Pa 1976) 2012;37:S144–64.

    Article  Google Scholar 

  16. Yagi M, Hosogane N, Okada E, et al. Factors affecting the postoperative progression of thoracic kyphosis in surgically treated adult patients with lumbar degenerative scoliosis. Spine (Phila Pa 1976) 2014;39:E521–8.

    Article  Google Scholar 

  17. Lewis SJ, Abbas H, Chua S, et al. Upper instrumented vertebral fractures in long lumbar fusions: what are the associated risk factors? Spine 2012;37:1407–14.

    Article  Google Scholar 

  18. Kolessar DJ, Stollsteimer GT, Betz RR. The value of the measurement from T5 to T12 as a screening tool in detecting abnormal kyphosis. J Spinal Disord 1996;9:220–2.

    Article  CAS  Google Scholar 

  19. Boseker EH, Moe JH, Winter RB, et al. Determination of “normal” thoracic kyphosis: a roentgenographic study of 121 “normal” children. J Pediatr Orthop 2000;20:796–8.

    Article  CAS  Google Scholar 

  20. Mac-Thiong JM, Berthonnaud E, Dimar 2nd JR, et al. Sagittal alignment of the spine and pelvis during growth. Spine (Phila Pa 1976) 2004;29:1642–7.

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Orthopaedics, Toronto Western Hospital, University Health Network, 399 Bathurst Street 1-E442, Toronto, Ontario, M5T 2S8, Canada

    Stephen J. Lewis MD, MSc, FRCS (C), Taylor E. Dear BSc, Michael G. Zywiel MD, Sam G. Keshen BSc, Y. Raja Rampersaud MD, FRCS (C) & Sofia P. Magana BSc

Authors
  1. Stephen J. Lewis MD, MSc, FRCS (C)
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  2. Taylor E. Dear BSc
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  3. Michael G. Zywiel MD
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  4. Sam G. Keshen BSc
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  5. Y. Raja Rampersaud MD, FRCS (C)
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  6. Sofia P. Magana BSc
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Corresponding author

Correspondence to Stephen J. Lewis MD, MSc, FRCS (C).

Additional information

Conflicts of Interest and Source of Funding: None of the authors received financial support in relation to this manuscript.

Author disclosures

SJL (personal fees from Stryker, personal fees from Medtronic, personal fees from AO Spine, outside the submitted work); TED (none); MGZ (none); SGK (none); YRR (none); SPM (none).

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Lewis, S.J., Dear, T.E., Zywiel, M.G. et al. T12 Sagittal Tilt Predicts Thoracic Kyphosis. Spine Deform 4, 112–119 (2016). https://doi.org/10.1016/j.jspd.2015.10.002

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  • DOI: https://doi.org/10.1016/j.jspd.2015.10.002

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