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European Spine Journal

, Volume 28, Issue 9, pp 2179–2186 | Cite as

Sequential correction technique to avoid postoperative global coronal decompensation in rigid adult spinal deformity: a technical note and preliminary results

  • Hongda Bao
  • Zhen Liu
  • Yuancheng Zhang
  • Xu Sun
  • Jun Jiang
  • Bangping Qian
  • Saihu Mao
  • Yong Qiu
  • Zezhang ZhuEmail author
Original Article

Abstract

Purpose

This study aims to evaluate this new sequential correction technique for preventing postoperative coronal imbalance.

Methods

Adult Spinal deformity (ASD) patients were stratifies into two types: primary thoracolumbar/lumbar (TL/L) curve with compensatory lumbosacral (LS) curve (Type I) and primary LS curve with compensatory TL/L curve (Type II): for Type I patients: correction of major TL/L curve and one- or two-level segmental rod installed at the convexity of the TL/L curve, L4-S1 TLIF to correct fractional curve and a short rod installed on the contralateral side and installation of long rods; for Type II patients: horizontalize L4 and L5, short rod installation at the convexity of the LS curve, distraction of curve with regional rod and installation of long rods. ASD patients were enrolled with inclusion criteria: with pre-op TL/L Cobb angle more than 30°, with pelvic fixation and with UIV over T10. Radiographic parameters were analyzed.

Results

Twenty-one patients were recruited (14 patients Type I and 7 Type II patients). Both Cobb angle and coronal offset were significantly improved after surgery. In Type I patients, Cobb angle was improved from 50.48° to 26.91° and coronal offset from 2.94 to 0.95 cm; in Type II patients, Cobb angle was improved from 61.42° to 28.48° and coronal offset from 2.82 to 1.38 cm. In the 10 patients with baseline coronal imbalance, 9 were corrected to coronal balance after surgery.

Conclusion

The sequential correction technique allows decomposing the complex correction surgery into several steps, and each step focuses only on one task. It can also reduce the difficulty of rod installation due to the separated maneuvers and multi-rod system.

Level of evidence

IV

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Sequential correction technique Adult spinal deformity Coronal imbalance Global coronal malalignment 

Notes

Acknowledgements

This work was supported by Jiangsu Provincial Key Medical Center (YXZXA2016009). This work received funding from Youth Fund of Natural Science Foundation of Jiangsu Province (BK20180122). This work received funding from Key Project supported by Medical Science and Technology Development Foundation, Nanjing Department of Health (YKK18092).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6043_MOESM1_ESM.pptx (3.1 mb)
Supplementary material 1 (PPTX 3159 kb)

References

  1. 1.
    Schwab F, Dubey A, Gamez L et al (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976) 30:1082–1085CrossRefGoogle Scholar
  2. 2.
    Schwab F, Ungar B, Blondel B et al (2012) Scoliosis research society—Schwab adult spinal deformity classification. Spine (Phila Pa 1976) 37:1077–1082.  https://doi.org/10.1097/brs.0b013e31823e15e2 CrossRefGoogle Scholar
  3. 3.
    Lafage V, Schwab FJ, Patel A et al (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976) 34:E599–E606.  https://doi.org/10.1097/brs.0b013e3181aad219 CrossRefGoogle Scholar
  4. 4.
    Glassman SD, Berven S, Bridwell K et al (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976) 30:682–688CrossRefGoogle Scholar
  5. 5.
    Ploumis A, Simpson AK, Cha TD et al (2013) Coronal spinal balance in adult spine deformity patients with long spinal fusions: A minimum 2-5 year follow-up study. J Spinal Disord Tech.  https://doi.org/10.1097/bsd.0b013e3182aab2ff CrossRefGoogle Scholar
  6. 6.
    Moal B, Schwab FJ, Ames CP et al (2014) Radiographic outcomes of adult spinal deformity correction: a critical analysis of variability and failures across deformity patterns. Spine Deform 2:219–225.  https://doi.org/10.1016/j.jspd.2014.01.003 CrossRefPubMedGoogle Scholar
  7. 7.
    Bao H, Yan P, Qiu Y et al (2016) Coronal imbalance in degenerative lumbar scoliosis: prevalence and influence on surgical decision-making for spine osteotomy. Bone Jt J 98-B:1227–1233CrossRefGoogle Scholar
  8. 8.
    Cho W, Mason JR, Smith JS et al (2013) Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors: clinical article. J Neurosurg Spine 19:445–453.  https://doi.org/10.3171/2013.6.SPINE121129 CrossRefPubMedGoogle Scholar
  9. 9.
    Cecchinato R, Berjano P, Aguirre M-FI, Lamartina C (2015) Asymmetrical pedicle subtraction osteotomy in the lumbar spine in combined coronal and sagittal imbalance. Eur Spine J 24:66–71.  https://doi.org/10.1007/s00586-014-3669-0 CrossRefGoogle Scholar
  10. 10.
    Girod P-P, Hartmann S, Kavakebi P et al (2017) Asymmetric pedicle subtractionosteotomy (aPSO) guided by a 3D-printed model to correct a combined fixed sagittal and coronal imbalance. Neurosurg Rev 40:689–693.  https://doi.org/10.1007/s10143-017-0882-4 CrossRefPubMedGoogle Scholar
  11. 11.
    Wang T, Liu H, Zheng Z et al (2013) Biomechanical effect of 4-rod technique on lumbosacral fixation: an in vitro human cadaveric investigation. Spine (Phila Pa 1976) 38:E925–E929.  https://doi.org/10.1097/brs.0b013e3182967968 CrossRefGoogle Scholar
  12. 12.
    Luca A, Ottardi C, Lovi A et al (2017) Anterior support reduces the stresses on the posterior instrumentation after pedicle subtraction osteotomy: a finite-element study. Eur Spine J.  https://doi.org/10.1007/s00586-017-5084-9 CrossRefPubMedGoogle Scholar
  13. 13.
    Merrill RK, Kim JS, Leven DM et al (2017) Multi-rod constructs can prevent rod breakage and pseudarthrosis at the lumbosacral junction in adult spinal deformity. Glob Spine J 7:514–520.  https://doi.org/10.1177/2192568217699392 CrossRefGoogle Scholar
  14. 14.
    Ishida W, Elder BD, Holmes C et al (2017) Comparison Between S2-Alar-Iliac screw fixation and iliac screw fixation in adult deformity surgery: reoperation rates and spinopelvic parameters. Glob Spine J 7:672–680.  https://doi.org/10.1177/2192568217700111 CrossRefGoogle Scholar
  15. 15.
    Ishida W, Elder BD, Holmes C et al (2016) S2-Alar-Iliac screws are associated with lower rate of symptomatic screw prominence than iliac screws: radiographic analysis of minimal distance from screw head to skin. World Neurosurg 93:253–260.  https://doi.org/10.1016/j.wneu.2016.06.042 CrossRefPubMedGoogle Scholar
  16. 16.
    Hoernschemeyer DG, Pashuck TD, Pfeiffer FM (2017) Analysis of the S2 Alar-Iliac screw as compared with the traditional iliac screw: does it increase stability with sacroiliac fixation of the spine? Spine J 17:875–879.  https://doi.org/10.1016/j.spinee.2017.02.001 CrossRefPubMedGoogle Scholar
  17. 17.
    Cecchinato R, Redaelli A, Martini C et al (2017) Long fusions to S1 with or without pelvic fixation can induce relevant acute variations in pelvic incidence: a retrospective cohort study of adult spine deformity surgery. Eur Spine J 26:436–441.  https://doi.org/10.1007/s00586-017-5154-z CrossRefPubMedGoogle Scholar
  18. 18.
    Tseng C, Liu Z, Bao H et al (2019) Long fusion to the pelvis with S2-Alar-Iliac screws can induce changes in pelvic incidence in adult spinal deformity patients: analysis of predictive factors in a retrospective cohort. Eur Spine J 28:138–145.  https://doi.org/10.1007/s00586-018-5738-2 CrossRefPubMedGoogle Scholar
  19. 19.
    Lee JH, Na KH, Kim JH et al (2016) Is pelvic incidence a constant, as everyone knows? Changes of pelvic incidence in surgically corrected adult sagittal deformity. Eur Spine J 25:3707–3714.  https://doi.org/10.1007/s00586-015-4199-0 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Spine Surgery, Drum Town HospitalNanjing University Medical SchoolNanjingChina

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