Restoring the ideal Roussouly sagittal profile in adult scoliosis surgery decreases the risk of mechanical complications

  • Javier PizonesEmail author
  • Lucía Moreno-Manzanaro
  • Francisco Javier Sánchez Pérez-Grueso
  • Alba Vila-Casademunt
  • Caglar Yilgor
  • Ibrahim Obeid
  • Ahmet Alanay
  • Frank Kleinstück
  • Emre R. Acaroglu
  • Ferran Pellisé
  • ESSG European Spine Study Group
Original Article



There are still no data proving whether restoring the ideal sagittal profile (according to Roussouly classification) in adult scoliosis (AS) patients leads to any additional benefit, especially regarding mechanical complications.


Retrospective analysis of operated AS patients recorded in a prospective multicenter database. Demographic and radiographic (preoperative and 6-week postoperative) data were analyzed. Patients with and without mechanical complications were compared looking especially at the surgical restoration of the ideal (based on Pelvic Incidence) sagittal profile. Univariate and multivariate analysis was performed to identify causes of mechanical complications at 2-year minimum follow-up.


Ninty-six AS patients were analyzed. Thirty-nine patients suffered a mechanical complication (18 PJK, 11 pseudoarthrosis, 10 screw pull-out), and 57 patients had no mechanical complications. Postoperatively, 72% of patients not matching the ideal Roussouly-type suffered mechanical complications compared to 15% of matched patients (P < 0.001). Univariate analysis showed that older patients 64.9 ± 13 versus 40.7 ± 15.6 years (P < 0.001), higher postoperative Global Tilt (27° vs. 14.7°) and Pelvic Tilt (25° vs. 16°) (P < 0.001), upper instrumented vertebra at the thoracolumbar junction (62% vs. 21%) (P < 0.001), fixation to the Iliac (76% vs. 6%) (P < 0.001), and postoperative Roussouly-type mismatch (72% vs. 15%) (P < 0.001) significantly increased the rate of mechanical complications. Multivariate logistic regression analysis selected: postoperative Roussouly-type mismatch (OR = 41.9; 95%CI = 5.5–315.7; P < 0.001), iliac instrumentation (OR = 19.4; 95%CI = 2.6–142.5; P = 0.004), and age (OR = 1.1; 95%CI = 1.02–1.16; P = 0.004), as the most important variables.


Adult scoliosis surgery should restore the ideal Roussouly sagittal profile to decrease the rate of mechanical complications, especially in patients older than 65, instrumented to the pelvis.

Graphical Abstract

These slides can be retrieved under Electronic Supplementary Material.


Adult scoliosis Roussouly classification Sagittal profiles Mechanical complications Adult deformity surgery 



Johnson and Johnson DePuy-Synthes Spine and Medtronic research grant were received in partial support of this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study has institutional review board (IRB) approval/research ethics committee approval.

Supplementary material

586_2019_6176_MOESM1_ESM.pptx (133 kb)
Supplementary material 1 (PPTX 133 kb)


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Copyright information

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

Authors and Affiliations

  • Javier Pizones
    • 1
    Email author
  • Lucía Moreno-Manzanaro
    • 1
  • Francisco Javier Sánchez Pérez-Grueso
    • 1
  • Alba Vila-Casademunt
    • 2
  • Caglar Yilgor
    • 3
  • Ibrahim Obeid
    • 4
  • Ahmet Alanay
    • 3
  • Frank Kleinstück
    • 5
  • Emre R. Acaroglu
    • 6
  • Ferran Pellisé
    • 7
  • ESSG European Spine Study Group
    • 2
  1. 1.Spine Unit, Department of Orthopedic SurgeryHospital Universitario La PazMadridSpain
  2. 2.Spine Research UnitVall d’Hebron Institute of ResearchBarcelonaSpain
  3. 3.Department of Orthopedics and TraumatologyAcibadem Mehmet Ali Aydinlar UniversityIstanbulTurkey
  4. 4.Spine Surgery UnitPellegrin University HospitalBordeauxFrance
  5. 5.Department of OrthopedicsSchulthess KlinikZurichSwitzerland
  6. 6.Orthopedic Spine UnitAnkara Spine CenterAnkaraTurkey
  7. 7.Spine Surgery UnitHospital Universitario Vall d’HebronBarcelonaSpain

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