Surgical management of coronal and sagittal imbalance of the spine without PSO: a multicentric cohort study on compensated adult degenerative deformities

  • Alessandro Ramieri
  • Massimo Miscusi
  • Maurizio Domenicucci
  • Antonino Raco
  • Giuseppe Costanzo
Original Article



Sagittal imbalance of severe adult degenerative deformities requires surgical correction to improve pain, mobility and quality of life. Our aim was a harmonic and balanced spine, treating a series of adult degenerative thoracolumbar and lumbar kyphoscoliosis by a non posterior subtraction osteotomy technique.


We operated 22 painful thoracolumbar and lumbar compensated degenerative deformities by anterior (ALIF), extreme lateral (XLIF) and transforaminal (TLIF) interbody fusion and grade 2 osteotomy (SPO) to restore lumbar lordosis and mobilize the coronal curve. Two-stage surgery, first anterior and after 2 or 3 weeks posterior, was proposed when the Oswestry Disability Index (ODI) was equal to or greater than 50% and VAS more than 5. All patients were submitted to X-ray and clinical screening during pre, post-operative and follow-up periods.


We performed 5 ALIFs, 39 XLIFs, 8 TLIFs, 32 SPOs. No major complications were recorded and complication rate was 18% after lateral fusion and 22.7% after posterior approach. Pelvic tilt, lumbar lordosis, sagittal vertical axis and thoracic kyphosis improved (p < 0.05). Clinical follow-up (mean 20.5; range 18–24) was satisfactory in all cases, except for two due to sacroiliac pain. Mean preoperative VAS was 7.7 (range 6–10), while ODI was 67% on average (range 50–78). After two-stage surgery, VAS and ODI decreased, respectively, to 2.4 (range 2–4) and 31% (range 25–45), while their values were 4 (range 2-6) and 35% (range 20–55) at the final follow-up.


Current follow-up does not allow definitive conclusions. However, the surgical approach adopted in this study seems promising, improving balance and clinical condition of adult patients with a compensated sagittal degenerative imbalance of the thoracolumbar spine.


Scoliosis Kyphosis Adult degenerative spine Osteotomy Interbody fusion 


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Alessandro Ramieri
    • 1
    • 5
  • Massimo Miscusi
    • 2
  • Maurizio Domenicucci
    • 3
  • Antonino Raco
    • 2
  • Giuseppe Costanzo
    • 4
  1. 1.OrthopaedicsDon Gnocchi Foundation, ONLUSMilanItaly
  2. 2.NeurosurgeryS. Andrea HospitalRomeItaly
  3. 3.Department Neurology and PsychiatryNeurosurgery, Sapienza Rome UniversityRomeItaly
  4. 4.OrthopaedicsPolo Pontino Sapienza Rome UniversityLatinaItaly
  5. 5.RomeItaly

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